ErbB ANTAGONISTS FOR PAIN THERAPY

ABSTRACT

The present application describes the use of ErbB antagonist, especially ErbB2 antibodies such as rhuMAb 2C4, for treating pain.

CROSS-REFERENCE TO RELATED APPLICATION(S)

The is a non-provisional application filed under 37 CFR 1.53(b),claiming priority under USC Section 119(e) to Provisional ApplicationSer. No. 60/561,076, filed on Apr. 8, 2004.

FIELD OF THE INVENTION

The present invention concerns ErbB antagonists for treating pain.

BACKGROUND OF THE INVENTION Anti-ErbB Antibodies and their Use in CancerTreatment

The ErbB family of receptor tyrosine kinases are important mediators ofcell growth, differentiation and survival. The receptor family includesfour distinct members including epidermal growth factor receptor (EGFRor ErbB1), HER2 (ErbB2 or p185^(neu)), HER3 (ErbB3) and HER4 (ErbB4 ortyro2).

EGFR, encoded by the erbB1 gene, has been causally implicated in humanmalignancy. In particular, increased expression of EGFR has beenobserved in breast, bladder, lung, head, neck and stomach cancer as wellas glioblastomas. Increased EGFR receptor expression is often associatedwith increased production of the EGFR ligand, transforming growth factoralpha (TGF-α), by the same tumor cells resulting in receptor activationby an autocrine stimulatory pathway. Baselga and Mendelsohn Pharmac.Ther. 64:127-154 (1994). Monoclonal antibodies directed against the EGFRor its ligands, TGF-α and EGF, have been evaluated as therapeutic agentsin the treatment of such malignancies. See, e.g., Baselga andMendelsohn., supra; Masui et al. Cancer Research 44:1002-1007 (1984);and Wu et al. J. Clin Invest. 95:1897-1905 (1995).

The second member of the ErbB family, p185^(neu), was originallyidentified as the product of the transforming gene from neuroblastomasof chemically treated rats. The activated form of the neu proto-oncogeneresults from a point mutation (valine to glutamic acid) in thetransmembrane region of the encoded protein. Amplification of the humanhomolog of neu is observed in breast and ovarian cancers and correlateswith a poor prognosis (Slamon et al., Science, 235:177-182 (1987);Slamon et al., Science, 244:707-712 (1989); and U.S. Pat. No.4,968,603). To date, no point mutation analogous to that in the neuproto-oncogene has been reported for human tumors. Overexpression ofErbB2 (frequently but not uniformly due to gene amplification) has alsobeen observed in other carcinomas including carcinomas of the stomach,endometrium, salivary gland, lung, kidney, colon, thyroid, pancreas andbladder. See, among others, King et al., Science, 229:974 (1985); Yokotaet al., Lancet: 1:765-767 (1986); Fukushige et al., Mol Cell Biol.,6:955-958 (1986); Guerin et al., Oncogene Res., 3:21-31 (1988); Cohen etOncogene, 4:81-88 (1989); Yonemura et al., Cancer Res., 51:1034 (1991);Borst et al., Gynecol. Oncol., 38:364 (1990); Weiner et al., CancerRes., 50:421-425 (1990); Kern et al., Cancer Res., 50:5184 (1990); Parket al., Cancer Res., 49:6605 (1989); Zhau et al., Mol. Carcinog.,3:354-357 (1990); Aasland et al. Br. J. Cancer 57:358-363 (1988);Williams et al. Pathiobiology 59:46-52 (1991); and McCann et al.,Cancer, 65:88-92 (1990). ErbB2 may be overexpressed in prostate cancer(Gu et al. Cancer Lett. 99:185-9 (1996); Ross et al. Hum. Pathol.28:827-33 (1997); Ross et al. Cancer 79:2162-70 (1997); and Sadasivan etal. J. Urol. 150:126-31 (1993)).

Antibodies directed against the rat p185^(neu) and human ErbB2 proteinproducts have been described. Drebin and colleagues have raisedantibodies against the rat neu gene product, p185^(neu) See, forexample, Drebin et al., Cell 41:695-706 (1985); Myers et al., Meth.Enzym. 198:277-290 (1991); and WO94/22478. Drebin et al. Oncogene2:273-277 (1988) report that mixtures of antibodies reactive with twodistinct regions of p185′ result in synergistic anti-tumor effects onneu-transformed NIH-3T3 cells implanted into nude mice. See also U.S.Pat. No. 5,824,311 issued Oct. 20, 1998.

Hudziak et al., Mol. Cell. Biol. 9(3):1165-1172 (1989) describe thegeneration of a panel of anti-ErbB2 antibodies which were characterizedusing the human breast tumor cell line SK-BR-3. Relative cellproliferation of the SK-BR-3 cells following exposure to the antibodieswas determined by crystal violet staining of the monolayers after 72hours. Using this assay, maximum inhibition was obtained with theantibody called 4D5 which inhibited cellular proliferation by 56%. Otherantibodies in the panel reduced cellular proliferation to a lesserextent in this assay. The antibody 4D5 was further found to sensitizeErbB2-overexpressing breast tumor cell lines to the cytotoxic effects ofTNF-α. See also U.S. Pat. No. 5,677,171 issued Oct. 14, 1997. Theanti-ErbB2 antibodies discussed in Hudziak et al. are furthercharacterized in Fendly et al. Cancer Research 50:1550-1558 (1990);Kotts et al. In Vitro 26(3):59A (1990); Sarup et al. Growth Regulation1:72-82 (1991); Shepard et al. J. Clin. Immunol. 11(3):117-127 (1991);Kumar et al. Mol. Cell. Biol. 11(2):979-986 (1991); Lewis et al. CancerImmunol. Immunother. 37:255-263 (1993); Pietras et al. Oncogene9:1829-1838 (1994); Vitetta et al. Cancer Research 54:5301-5309 (1994);Sliwkowski et al. J. Biol. Chem. 269(20):14661-14665 (1994); Scott etal. J. Biol. Chem. 266:14300-5 (1991); D'souza et al. Proc. Natl. Acad.Sci. 91:7202-7206 (1994); Lewis et al. Cancer Research 56:1457-1465(1996); and Schaefer et al. Oncogene 15:1385-1394 (1997).

A recombinant humanized version of the murine anti-ErbB2 antibody 4D5(huMAb4D5-8, rhuMAb HER2 or HERCEPTIN®; U.S. Pat. No. 5,821,337) isclinically active in patients with ErbB2-overexpressing metastaticbreast cancers that have received extensive prior anti-cancer therapy(Baselga et al., J. Clin. Oncol. 14:737-744 (1996)). HERCEPTIN® receivedmarketing approval from the Food and Drug Administration Sep. 25, 1998for the treatment of patients with metastatic breast cancer whose tumorsoverexpress the ErbB2 protein.

Other anti-ErbB2 antibodies with various properties have been describedin Tagliabue et al. Int. J. Cancer 47:933-937 (1991); McKenzie et al.Oncogene 4:543-548 (1989); Maier et al. Cancer Res. 51:5361-5369 (1991);Bacus et al. Molecular Carcinogenesis 3:350-362 (1990); Stancovski etal. PNAS (USA) 88:8691-8695 (1991); Bacus et al. Cancer Research52:2580-2589 (1992); Xu et al. Int. J. Cancer 53:401-408 (1993);WO94/00136; Kasprzyk et al. Cancer Research 52:2771-2776 (1992); Hancocket al. Cancer Res. 51:4575-4580 (1991); Shawver et al. Cancer Res.54:1367-1373 (1994); Arteaga et al. Cancer Res. 54:3758-3765 (1994);Harwerth et al. J. Biol. Chem. 267:15160-15167 (1992); U.S. Pat. No.5,783,186; and Klapper et al. Oncogene 14:2099-2109 (1997).

Homology screening has resulted in the identification of two other ErbBreceptor family members; ErbB3 (U.S. Pat. Nos. 5,183,884 and 5,480,968as well as Kraus et al. PNAS (USA) 86:9193-9197 (1989)) and ErbB4 (EPPat Appln No 599,274; Plowman et al., Proc. Natl. Acad. Sci. USA,90:1746-1750 (1993); and Plowman et al., Nature, 366:473-475 (1993)).Both of these receptors display increased expression on at least somebreast cancer cell lines.

The ErbB receptors are generally found in various combinations in cellsand heterodimerization is thought to increase the diversity of cellularresponses to a variety of ErbB ligands (Earp et al. Breast CancerResearch and Treatment 35: 115-132 (1995)). EGFR is bound by sixdifferent ligands; epidermal growth factor (EGF), transforming growthfactor alpha (TGF-α), amphiregulin, heparin binding epidermal growthfactor (HB-EGF), betacellulin and epiregulin (Groenen et al. GrowthFactors 11:235-257 (1994)). A family of heregulin proteins resultingfrom alternative splicing of a single gene are ligands for ErbB3 andErbB4. The heregulin family includes alpha, beta and gamma heregulins(Holmes et al., Science, 256:1205-1210 (1992); U.S. Pat. No. 5,641,869;and Schaefer et al. Oncogene 15:1385-1394 (1997)); neu differentiationfactors (NDFs), glial growth factors (GGFs); acetylcholine receptorinducing activity (ARIA); and sensory and motor neuron derived factor(SMDF). For a review, see Groenen et al. Growth Factors 11:235-257(1994); Lemke, G. Molec. & Cell. Neurosci. 7:247-262 (1996) and Lee etal. Pharm. Rev. 47:51-85 (1995). Recently three additional ErbB ligandswere identified; neuregulin-2 (NRG-2) which is reported to bind eitherErbB3 or ErbB4 (Chang et al. Nature 387 509-512 (1997); and Carraway etal Nature 387:512-516 (1997)); neuregulin-3 which binds ErbB4 (Zhang etal. PNAS (USA) 94(18):9562-7 (1997)); and neuregulin-4 which binds ErbB4(Harari et al. Oncogene 18:2681-89 (1999)) HB-EGF, betacellulin andepiregulin also bind to ErbB4.

While EGF and TGFα do not bind ErbB2, EGF stimulates EGFR and ErbB2 toform a heterodimer, which activates EGFR and results intransphosphorylation of ErbB2 in the heterodimer. Dimerization and/ortransphosphorylation appears to activate the ErbB2 tyrosine kinase. SeeEarp et al., supra. Likewise, when ErbB3 is co-expressed with ErbB2, anactive signaling complex is formed and antibodies directed against ErbB2are capable of disrupting this complex (Sliwkowski et al., J. Biol.Chem., 269(20):14661-14665 (1994)). Additionally, the affinity of ErbB3for heregulin (HRG) is increased to a higher affinity state whenco-expressed with ErbB2. See also, Levi et al., Journal of Neuroscience15: 1329-1340 (1995); Morrissey et al., Proc. Natl. Acad. Sci. USA 92:1431-1435 (1995); and Lewis et al., Cancer Res., 56:1457-1465 (1996)with respect to the ErbB2-ErbB3 protein complex. ErbB4, like ErbB3,forms an active signaling complex with ErbB2 (Carraway and Cantley, Cell78:5-8 (1994)).

Pain Management

Chronic pain is a common symptom of a variety of diseases and pathologicconditions, and includes nociceptive pain (pain caused by an injury tobody tissues), neuropathic pain (pain caused by abnormalities in thenerves, spinal cord, or brain), and psychogenic pain (entirely or mostlyrelated to a psychological disorder). Nociceptive pain includes somaticpain, which arises from bone, joint, muscle, skin, or connective tissue,and visceral pain, which arises from visceral organs, such as thegastrointestinal tract and the pancreas.

Mild to moderate pain is typically treated by nonsteroidalantiinflammatory drugs (NSAIDs), such as acetaminophen, ibuprofen,aspirin, ketorolac, etodolac, and the like. Treatment of more severechronic pain may include opiate and NSA/D combinations, such as aspirinand oxycodone (Percodan), acetaminophen and hydrocodone (Vicodin andLortab).

Pain is also a frequent symptom of advanced cancer. For example, about60% of patients with hormone-refractory prostate cancer suffersignificant pain. Typically the pain results directly from the cancer(including cancer metastasis), although sometimes it can also beassociated with the cancer treatment itself For example, chronic painmay develop if there has been nerve damage during surgical removal ofcancer. Chemotherapy can also cause pain in several ways. Somechemotherapy drugs, referred to as vesicants, can harm tissues if theyleak out of the vein. In some instances, chemotherapy causes sores inthe mouth (stomatitis) or lining of the intestines (mucositis).Peripheral neuropathy can occur with certain chemotherapy drugs whenthey are administered long-term in high doses. Radiation treatment canalso cause pain because it can affect normal cells that surround thecancerous tumor being treated.

At present, cancer-related pain is usually managed by opiate analgesics,such as morphine or heroin with the goal to relieve the patient's painby adjusting the opiate dosage to maintain a pain score of 3 or less ona 10-point visual analog scale. This treatment, however, is not optimal.Common side effects include drowsiness and constipation. In addition,patients often experience tolerance and develop a physical dependency onopiate analgesics, which reduces the effectiveness of the pain treatmentand raises serious issues of drug dependency. When an opioid isdiscontinued, withdrawal symptoms may appear, the character and severityof which are dependent upon such factors as the particular opioid beingwithdrawn, the daily dose of the opioid that is being withdrawn, theduration of opioid treatment, and the condition of the drug-dependentindividual. Withdrawal itself is associated with symptoms includingsevere pain. Often the only effective treatment for cancer-related painis successful eradication of the tumor.

Severe, persisting pain is debilitating for patients and theircaregivers, and is often under-treated due to fear of opioid addition byboth patients and medical professionals. Since current therapies areunsatisfactory, it is important to develop further treatment modalitiesfor the management of chronic pain, including cancer-related pain, thatare more effective and are devoid of the undesired side-effects andrisks associated with current treatment approaches.

SUMMARY OF THE INVENTION

This invention is based, at least in part, on the surprising observationthat patients with prostate cancer treated with an ErbB antagonist,namely rhuMAb 2C4, experienced diminished pain or showed reducedanalgesia requirement, even where the tumor was progressing. Thisindicates that rhuMAb 2C4 has analgesic properties.

In one aspect, the invention concern a method of treating pain in apatient comprising administering an effective dose of an ErbB antagonistto the patient.

In another aspect, the invention concerns a method of treating pain in apatient comprising administering an ErbB antagonist to the patient in adose confirmed to reduce or eliminate the pain or the analgesiarequirement of the patient.

In one embodiment, the pain is measured by a pain score or quality oflife score reflective of pain. Pain may, for example, be measured by theMcGill Pain Index on a six point scale of 0 to 5. Pain may alternativelybe measured by using a visual analog scale of 0-100 reflective of thesubjective feeling of pain of the patient. The analgesia requirement maybe measured using an analgesia score. In a particular embodiment, onedose of a non-steroidal analgesic agent corresponds to an analgesiascore of 1, and one 10 mg dose of morphine, or an equivalent dose ofanother opiate analgesic agent corresponds to an analgesia score of 2.

In another embodiment, pain is monitored daily.

In yet another embodiment, analgesia requirement is monitored daily.

In another aspect, the invention concerns a method for treatingcancer-related pain in a patient diagnosed with cancer, comprisingadministering an effective amount of an ErbB antagonist to the patient,wherein the cancer is not in remission or continues to grow during saidtreatment.

In a specific embodiment of the method, the cancer is not in remissionduring said treatment, or continues to group during treatment.

The cancer can be any kind of cancer, including, for example, breastcancer, ovarian cancer, prostate cancer, pancreatic cancer, squamouscell cancer, lung cancer, cancer of the peritoneum, hepatocellularcancer, gastric cancer, glioblastoma, cervical cancer, liver cancer,bladder cancer, hepatoma, colon cancer, rectal cancer, colorectalcancer, endometrial or uterine carcinoma, salivary gland carcinoma,kidney cancer, vulval cancer, thyroid cancer, hepatic carcinoma, analcarcinoma, penile carcinoma, and head and neck cancer.

In a particular embodiment, the cancer is metastatic cancer.

In another embodiment, the metastasis is soft tissue metastasis.

In yet another embodiment, the metastasis includes bone metastasis.

In a preferred embodiment, the cancer is prostate cancer, specificallyincluding androgen independent prostate cancer.

In another embodiment, the cancer is prostate cancer, and the patient'sPSA shows no reduction during treatment, or becomes elevated duringtreatment.

In a further aspect, the invention concerns a method for treatingnon-cancer related pain in a patient comprising administering aneffective amount of an ErbB antagonist to the patient.

In a still further aspect, the invention concerns a kit comprising aneffective amount of an ErbB antagonist, and instructions to administersaid antagonist for the treatment of pain.

In all aspects, the ErbB antagonist preferably is an antibody. Theantibody can, for example, be a monoclonal antibody that binds an ErbB.In another embodiment, the antibody blocks ligand activation of an ErbB.In yet another embodiment, the antibody blocks formation of an ErbBheterodimer. In a preferred embodiment, the antibody blocks binding ofmonoclonal antibody 2C4 to ErbB2. In another preferred embodiment, theantibody has a biological characteristic of monoclonal antibody 2C4. Ina further preferred embodiment, the antibody comprises monoclonalantibody 2C4 or humanized 2C4.

The antibody may be an antibody fragment, such as, for example, a Fabfragment and may, or may not be conjugated with a cytotoxic agent.

The pain treated in accordance with the present invention can be acutepain or chronic pain, such as, without limitation., nociceptive pain,neuropathic pain and psychogenic pain, and can be cancer related or notassociated with cancer. When the pain is cancer related the cancer may,but does not have to, express an ErbB receptor, such as, ErbB2 and/orEGFR. In a specific embodiment, the cancer is metastatic cancer, wherethe metastasis can be soft tissue and/or bone metastasis.

In another embodiment, the cancer is selected from the group consistingof breast cancer, ovarian cancer, prostate cancer, pancreatic cancer,squamous cell cancer, lung cancer, cancer of the peritoneum,hepatocellular cancer, gastric cancer, glioblastoma, cervical cancer,liver cancer, bladder cancer, hepatoma, colon cancer, rectal cancer,colorectal cancer, endometrial or uterine carcinoma, salivary glandcarcinoma, kidney cancer, vulval cancer, thyroid cancer, hepaticcarcinoma, anal carcinoma, penile carcinoma, and head and neck cancer.

In a particular embodiment, the cancer is prostate cancer, such as, forexample, androgen independent prostate cancer.

BRIEF DESCRIPTION OF THE DRAWINGS

FIGS. 1A and 1B depict epitope mapping of residues 22-645 within theextracellular domain (ECD) of ErbB2 (amino acid sequence, includingsignal sequence, shown in FIG. 1A; SEQ ID NO:13) as determined bytruncation mutant analysis and site-directed mutagenesis (Nakamura etal. J. of Virology 67(10):6179-6191 (1993); and Renz et al. J. CellBiol. 125(6):1395-1406 (1994)). The various ErbB2-ECD truncations orpoint mutations were prepared from cDNA using polymerase chain reactiontechnology. The ErbB2 mutants were expressed as gD fusion proteins in amammalian expression plasmid. This expression plasmid uses thecytomegalovirus promoter/enhancer with SV40 termination andpolyadenylation signals located downstream of the inserted cDNA. PlasmidDNA was transfected into 293 cells. One day following transfection, thecells were metabolically labeled overnight in methionine andcysteine-free, low glucose DMEM containing 1% dialyzed fetal bovineserum and 25 μCi each of ³⁵S methionine and ³⁵S cysteine. Supernatantswere harvested and either the anti-ErbB2 monoclonal antibodies orcontrol antibodies were added to the supernatant and incubated 2-4 hoursat 4° C. The complexes were precipitated, applied to a 10-20% TricineSDS gradient gel and electrophoresed at 100 V. The gel waselectroblotted onto a membrane and analyzed by autoradiography. As shownin FIG. 1B, the anti-ErbB2 antibodies 7C2, 7F3, 2C4, 7D3, 3E8, 4D5, 2H11and 3H4 bind various ErbB2 ECD epitopes.

FIGS. 2A and 2B show the effect of anti-ErbB2 monoclonal antibodies 2C4and 7F3 on rHRGβ1 activation of MCF7 cells. FIG. 2A shows dose-responsecurves for 2C4 or 7F3 inhibition of HRG stimulation of tyrosinephosphorylation. FIG. 2B shows dose-response curves for the inhibitionof ¹²⁵I-labeled rHRGβ1₁₇₇₋₂₄₄ binding to MCF7 cells by 2C4 or 7F3.

FIG. 3 depicts inhibition of specific ¹²⁵I-labeled rHRGβ1₁₇₇₋₂₄₄ bindingto a panel of human tumor cell lines by the anti-ErbB2 monoclonalantibodies 2C4 or 7F3. Monoclonal antibody-controls are isotype-matchedmurine monoclonal antibodies that do not block rHRG binding. Nonspecific¹²⁵I-labeled rHRGβ1₁₇₇₋₂₄₄ binding was determined from parallelincubations performed in the presence of 100 nM rHRGβ1. Values fornonspecific ¹²⁵I-labeled rHRGβ1₁₇₇₋₂₄₄ binding were less than 1% of thetotal for all the cell lines tested.

FIGS. 4A and 4B show the effect of monoclonal antibodies 2C4 and 4D5 onproliferation of MDA-MB-175 (FIG. 4A) and SK-BR-3 (FIG. 4B) cells.MDA-MB-175 and SK-BR-3 cells were seeded in 96 well plates and allowedto adhere for 2 hours. Experiment was carried out in medium containing1% serum. Anti-ErbB2 antibodies or medium alone were added and the cellswere incubated for 2 hours at 37° C. Subsequently rHRGβ1 (1 nM) ormedium alone were added and the cells were incubated for 4 days.Monolayers were washed and stained/fixed with 0.5% crystal violet. Todetermine cell proliferation the absorbance was measured at 540 nm.

FIGS. 5A and 5B show the effect of monoclonal antibody 2C4, HERCEPTIN®antibody or an anti-EGFR antibody on heregulin (HRG) dependentassociation of ErbB2 with ErbB3 in MCF7 cells expressing low/normallevels of ErbB2 (FIG. 5A) and SK-BR-3 cells expressing high levels ofErbB2 (FIG. 5B); see Example 2 below.

FIGS. 6A and 6B compare the activities of intact murine monoclonalantibody 2C4 (mu 2C4) and a chimeric 2C4 Fab fragment. FIG. 6A showsinhibition of ¹²⁵I-HRG binding to MCF7 cells by chimeric 2C4 Fab orintact murine monoclonal antibody 2C4. MCF7 cells were seeded in 24-wellplates (1×10⁵ cells/well) and grown to about 85% confluency for twodays. Binding experiments were conducted as described in Lewis et al.Cancer Research 56:1457-1465 (1996). FIG. 6B depicts inhibition ofrHRGβ1 activation of p180 tyrosine phosphorylation in MCF7 cellsperformed as described in Lewis et al. Cancer Research 56:1457-1465(1996).

FIGS. 7A and 7B depict alignments of the amino acid sequences of thevariable light (V_(L)) (FIG. 7A) and variable heavy (V_(H)) (FIG. 7B)domains of murine monoclonal antibody 2C4 (SEQ ID Nos. 1 and 2,respectively); V_(L) and V_(H) domains of humanized 2C4 version 574 (SEQID Nos. 3 and 4, respectively), and human V_(L) and V_(H) consensusframeworks (hum κ1, light kappa subgroup I; humIII, heavy subgroup III)(SEQ ID Nos. 5 and 6, respectively). Asterisks identify differencesbetween humanized 2C4 version 574 and murine monoclonal antibody 2C4 orbetween humanized 2C4 version 574 and the human framework.Complementarity Determining Regions (CDRs) are in brackets.

FIGS. 8A to C show binding of chimeric Fab 2C4 (Fab.v1) and severalhumanized 2C4 variants to ErbB2 extracellular domain (ECD) as determinedby ELISA in Example 3.

FIG. 9 is a ribbon diagram of the V_(L) and V_(H) domains of monoclonalantibody 2C4 with white CDR backbone labeled (L1, L2, L3, H1, H2, H3).V_(H) side chains evaluated by mutagenesis during humanization (seeExample 3, Table 2) are also shown.

FIG. 10 depicts the effect of monoclonal antibody 2C4 or HERCEPTIN® onEGF, TGF-α, or HRG-mediated activation of mitogen-activated proteinkinase (MAPK).

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

Unless defined otherwise, technical and scientific terms used hereinhave the same meaning as commonly understood by one of ordinary skill inthe art to which this invention belongs. Singleton et al., Dictionary ofMicrobiology and Molecular Biology 2nd ed., J. Wiley & Sons (New York,N.Y. 1994) provides one skilled in the art with a general guide to manyof the terms used in the present disclosure.

I. DEFINITIONS

The term “pain” is used herein in the broadest sense and refers to alltypes of pain, including acute and chronic pain, such as nociceptivepain, e.g. somatic pain and visceral pain; neuropathic pain, e.g.centrally generated pain and peripherally generated pain; andpsychogenic pain. The term preferably refers to chronic pain, mostpreferably nociceptive pain, including somatic pain and visceral pain,which can be cancer related, not associated with cancer, or onlypartially associated with cancer.

The term “nociceptive pain” is used to include all pain caused by injuryto body tissues, including, without limitation, by a cut, bruise, bonefracture, crush injury, burn, and the like. This type of pain istypically aching, sharp, or throbbing. Pain receptors for tissue injury(nociceptor) are located mostly in the skin or in the internal organs.

The term “somatic pain” is used to refer to pain arising from bone,joint, muscle, skin, or connective tissue. This type of pain istypically aching or throbbing in quality and is well localized.

The term “visceral pain” is used herein to refer to pain arising fromvisceral organs, such as the gastrointestinal tract and pancreas.Visceral pain includes aching and fairly well localized pain caused bytumor involvement of the organ capsule. Another type of visceral pain,which is typically caused by obstruction of hollow viscus, ischaracterized by intermittent cramping and poorly localized pain.

The term “neuropathic pain” is used herein to refer to pain originatingfrom abnormal processing of sensory input by the peripheral or centralnervous system.

The term “analgesia” is used to refer to the absence of pain in responseto a stimulus that would be normally painful and to a treatment with ananalgesic agent. The term “analgesic agent” and grammatical equivalentsthereof refer to agents that are capable of invoking analgesia.

The term “analgesia requirement” of a patient is used herein to refer tothe need of administering an analgesic agent (other than an ErbBantagonist) to a patient in order to manage the patient's pain.

“Treatment” refers to both therapeutic treatment and prophylactic orpreventative measures. Those in need of treatment include those alreadyexperiencing pain as well as those in which pain is to be prevented.

The term “effective amount” refers to an amount of the ErbB antagonisteffective to reduce pain, at least to some extent, or to reduce oreliminate the analgesia requirement while maintaining the same orreduced pain score or subjective feeling of pain as experienced underanalgesia, prior to the administration of the ErbB antagonist. Pain andreduction in pain can be evaluated by using any of the pain scoresystems well known in the art of pain management and/or a Quality ofLife Score system for pain. Preferably, pain is measured based on theMcGill Pain Index using a 6 point scale (0-5), where 0=no pain, 1=mildpain, 2=discomforting pain, 3=distressing pain, 4=horrible pain,5=excruciating pain. Quality of Life Score for pain can be determinedusing a visual analog scale of 0-100.

The terms “cancer” and “cancerous” refer to or describe thephysiological condition in mammals that is typically characterized byunregulated cell growth. Examples of cancer include, but are not limitedto, carcinoma, lymphoma, blastoma, sarcoma, and leukemia or lymphoidmalignancies. More particular examples of such cancers include squamouscell cancer (e.g. epithelial squamous cell cancer), lung cancerincluding small-cell lung cancer, non-small cell lung cancer,adenocarcinoma of the lung and squamous carcinoma of the lung, cancer ofthe peritoneum, hepatocellular cancer, gastric or stomach cancerincluding gastrointestinal cancer, pancreatic cancer, glioblastoma,cervical cancer, ovarian cancer, liver cancer, bladder cancer, hepatoma,breast cancer, colon cancer, rectal cancer, colorectal cancer,endometrial or uterine carcinoma, salivary gland carcinoma, kidney orrenal cancer, prostate cancer, vulval cancer, thyroid cancer, hepaticcarcinoma, anal carcinoma, penile carcinoma, as well as head and neckcancer.

The term “PSA” is used herein to refer to the level of aprostate-specific antigen in the blood produced by the prostate, asdetermined by the prostate-specific antigen test. The amount of thisantigen increases if the prostate is cancerous, and typically continuesto increase as the cancer progresses.

An “ErbB” is a receptor protein tyrosine kinase which belongs to theErbB receptor family and includes EGFR, ErbB2, ErbB3 and ErbB4 receptorsand other members of this family to be identified in the future. TheErbB will generally comprise an extracellular domain, which may bind anErbB ligand; a lipophilic transmembrane domain; a conservedintracellular tyrosine kinase domain; and a carboxyl-terminal signalingdomain harboring several tyrosine residues which can be phosphorylated.The ErbB may be a “native sequence” ErbB or an “amino acid sequencevariant” thereof. Preferably the ErbB is native sequence human ErbB.

The terms “ErbB1”, “epidermal growth factor receptor,” “HER1,” and“EGFR” are used interchangeably herein and refer to EGFR as disclosed,for example, in Carpenter et al. Ann. Rev. Biochem. 56:881-914 (1987),including naturally occurring mutant forms thereof (e.g. a deletionmutant EGFR as in Humphrey et al. PNAS (USA) 87:4207-4211 (1990); typeII EGFR mutant (U.S. Pat. No. 6,455,498) etc). erbB1 refers to the geneencoding the EGFR protein product.

The expressions “ErbB2” and “HER2” are used interchangeably herein andrefer to human HER2 protein described, for example, in Semba et al.,PNAS (USA) 82:6497-6501 (1985) and Yamamoto et al. Nature 319:230-234(1986) (Genebank accession number X03363). The term “erbB2” refers tothe gene encoding human ErbB2 and “neu” refers to the gene encoding ratp185^(neu). Preferred ErbB2 is native sequence human ErbB2.

“ErbB3” and “HERS” refer to the receptor polypeptide as disclosed, forexample, in U.S. Pat. Nos. 5,183,884 and 5,480,968 as well as Kraus etal. PNAS (USA) 86:9193-9197 (1989).

The terms “ErbB4” and “HER4” herein refer to the receptor polypeptide asdisclosed, for example, in EP Pat Appln No 599,274; Plowman et al.,Proc. Natl. Acad. Sci. USA, 90:1746-1750 (1993); and Plowman et al.,Nature, 366:473-475 (1993), including isoforms thereof, e.g., asdisclosed in WO99/19488, published Apr. 22, 1999.

By “ErbB ligand” is meant a polypeptide which binds to and/or activatesan ErbB. The term includes membrane-bound precursor forms of the ErbBligand, as well as proteolytically processed soluble forms of the ErbBligand. The ErbB ligand of particular interest herein is a nativesequence human ErbB ligand such as epidermal growth factor (EGF) (Savageet al., J. Biol. Chem. 247:7612-7621 (1972)); transforming growth factoralpha (TGF-α) (Marquardt et al., Science 223:1079-1082 (1984));amphiregulin also known as schwanoma or keratinocyte autocrine growthfactor (Shoyab et al. Science 243:1074-1076 (1989); Kimura et al. Nature348:257-260 (1990); and Cook et al. Mol. Cell. Biol. 11:2547-2557(1991)); betacellulin (Shing et al., Science 259:1604-1607 (1993); andSasada et al. Biochem. Biophys. Res. Commun. 190:1173 (1993));heparin-binding epidermal growth factor (HB-EGF) (Higashiyama et al.,Science 251:936-939 (1991)); epiregulin (Toyoda et al., J. Biol. Chem.270:7495-7500 (1995); and Komurasaki et al. Oncogene 15:2841-2848(1997)); a heregulin (see below); neuregulin-2 (NRG-2) (Carraway et al.,Nature 387:512-516 (1997)); neuregulin-3 (NRG-3) (Zhang et al., Proc.Natl. Acad. Sci. 94:9562-9567 (1997)); neuregulin-4 (NRG-4) (Haran etal. Oncogene 18:2681-89 (1999)) or cripto (CR-1) (Kannan et al. J. Biol.Chem. 272(6):3330-3335 (1997)). ErbB ligands which bind EGFR includeEGF, TGF-α, amphiregulin, betacellulin, HB-EGF and epiregulin. ErbBligands which bind ErbB3 include heregulins. ErbB ligands capable ofbinding ErbB4 include betacellulin, epiregulin, HB-EGF, NRG-2, NRG-3,NRG-4 and heregulins.

“Heregulin” (HRG) when used herein refers to a polypeptide encoded bythe heregulin gene product as disclosed in U.S. Pat. No. 5,641,869 orMarchionni et al., Nature, 362:312-318 (1993). Examples of heregulinsinclude heregulin-α, heregulin-β1, heregulin-β2 and heregulin-β3 (Holmeset al., Science, 256:1205-1210 (1992); and U.S. Pat. No. 5,641,869); neudifferentiation factor (NDF) (Peles et al. Cell 69: 205-216 (1992));acetylcholine receptor-inducing activity (ARIA) (Falls et al. Cell72:801-815 (1993)); glial growth factors (GGFs) (Marchionni et al.,Nature, 362:312-318 (1993)); sensory and motor neuron derived factor(SMDF) (Ho et al. J. Biol. Chem. 270:14523-14532 (1995)); γ-heregulin(Schaefer et al. Oncogene 15:1385-1394 (1997)). The term includesbiologically active fragments and/or amino acid sequence variants of anative sequence HRG polypeptide, such as an EGF-like domain fragmentthereof (e.g. HRGβ1₁₇₇₋₂₄₄).

An “ErbB hetero-oligomer” herein is a noncovalently associated oligomercomprising at least two different ErbBs. Such complexes may form when acell expressing two or more ErbBs is exposed to an ErbB ligand(Sliwkowski et al., J. Biol. Chem., 269(20):14661-14665 (1994)).Examples of such ErbB hetero-oligomers include EGFR-ErbB2, ErbB2-ErbB3and ErbB3-ErbB4 complexes. Moreover, the ErbB hetero-oligomer maycomprise two or more ErbB2 receptors combined with a different ErbB,such as ErbB3, ErbB4 or EGFR. Other proteins, such as a cytokinereceptor subunit (e.g. gp130) may be included in the hetero-oligomer.The patient herein may have been subjected to an assay to determinewhether ErbB heterodimers, especially an EGFR-ErbB2 and/or ErbB2-ErbB3heterodimer are present in cells of the patient, e.g. in diseased tissuetherefrom.

By “ligand activation of an ErbB” is meant signal transduction (e.g.that caused by an intracellular kinase domain of an ErbB phosphorylatingtyrosine residues in the ErbB or a substrate polypeptide) mediated byErbB ligand binding to a ErbB hetero-oligomer comprising the ErbB ofinterest. Generally, this will involve binding of an ErbB ligand to anErbB hetero-oligomer which activates a kinase domain of one or more ofthe ErbBs in the hetero-oligomer and thereby results in phosphorylationof tyrosine residues in one or more of the ErbBs and/or phosphorylationof tyrosine residues in additional substrate polypeptides(s). ErbBactivation can be quantified using various tyrosine phosphorylationassays.

An “ErbB antagonist” is a molecule which blocks (reduces or prevents) abiological activity of one or more ErbB(s). Preferably, the antagonistblocks (reduces or prevents) ligand activation of an ErbB. Generally,the antagonist will be an antibody, small peptide or non-peptide(organic) molecule, antisense molecule, oligonucleotide decoy, and thelike, which inhibits a biological activity of an ErbB receptor. Thus,for example, an antagonist may bind to or otherwise associate with anErbB and reduce tyrosine kinase activation thereof. ErbB antagonistsalso include molecules that bind to or associate with ErbB ligands orother members of the ErbB signaling pathway, thereby inhibiting ErbBbiological activity. The preferred ErbB antagonist is an antibody thatbinds ErbB2, or EGFR, or a hetero-oligomer (e.g. a heterodimer)comprising ErbB2 and/or EGFR, and blocks ligand activation of an ErbB.The most preferred antagonist is rhuMAb 2C4 or a molecule having abiological characteristic of rhuMAb 2C4. By way of example, theantagonist may also be an EGFR-targeted drug and/or a tyrosine kinaseinhibitor.

As used herein, the term “EGFR-targeted drug” refers to a therapeuticagent that binds to EGFR and, optionally, inhibits EGFR activation.Examples of such agents include antibodies and small molecules that bindto EGFR. Examples of antibodies which bind to EGFR include MAb 579 (ATCCCRL HB 8506), MAb 455 (ATCC CRL HB8507), MAb 225 (ATCC CRL 8508), MAb528 (ATCC CRL 8509) (see, U.S. Pat. No. 4,943,533, Mendelsohn et al.)and variants thereof, such as chimerized 225 (C225 or Cetuximab;ERBUTIX®) and reshaped human 225 (11225) (see, WO 96/40210, ImcloneSystems Inc.); antibodies that bind type II mutant EGFR (U.S. Pat. No.5,212,290); humanized and chimeric antibodies that bind EGFR asdescribed in U.S. Pat. No. 5,891,996; and human antibodies that bindEGFR, such as ABX-EGF (see WO98/50433, Abgenix). The anti-EGFR antibodymay be conjugated with a cytotoxic agent, thus generating animmunoconjugate (see, e.g., EP659,439A2, Merck Patent GmbH). Examples ofsmall molecules that bind to EGFR include ZD1839 or Gefitinib (IRESSA®;Astra Zeneca), CP-358,774 (TARCEVA®; Genentech/OSI) and AG1478, AG1571(SU 5271; Sugen).

A “tyrosine kinase inhibitor” is a molecule which inhibits to someextent tyrosine kinase activity of a tyrosine kinase such as an ErbB.Examples of such inhibitors include the EGFR-targeted drugs noted in thepreceding paragraph as well as quinazolines such as PD153035,4-(3-chloroanilino) quinazoline, pyridopyrimidines,pyrimidopyrimidines, pyrrolopyrimidines, such as CGP 59326, CGP 60261and CGP 62706, and pyrazolopyrimidines,4-(phenylamino)-7H-pyrrolo[2,3-d]pyrimidines, curcumin (diferuloylmethane, 4,5-bis(4-fluoroanilino)phthalimide), tryphostines containingnitrothiophene moieties; PD-0183805 (Warner-Lamber); antisense molecules(e.g. those that bind to ErbB-encoding nucleic acid); quinoxalines (U.S.Pat. No. 5,804,396); tryphostins (U.S. Pat. No. 5,804,396); ZD6474(Astra Zeneca); PTK-787 (Novartis/Schering AG); pan-ErbB inhibitors suchas CI-1033 (Pfizer); Affinitac (ISIS 3521; Isis/Lilly); Imatinibmesylate (Gleevac; Novartis); PKI 166 (Novartis); GW2016 (GlaxoSmithKline); CI-1033 (Pfizer); EKB-569 (Wyeth); Semaxanib (Sugen);ZD6474 (AstraZeneca); PTK-787 (Novartis/Schering AG); INC-1C11(Imclone); or as described in any of the following patent publications:U.S. Pat. No. 5,804,396; WO99/09016 (American Cyanimid); WO98/43960(American Cyanamid); WO97/38983 (Warner Lambert); WO99/06378 (WarnerLambert); WO99/06396 (Warner Lambert); WO96/30347 (Pfizer, Inc);WO96/33978 (Zeneca); WO96/3397 (Zeneca); and WO96/33980 (Zeneca).

A “native sequence” polypeptide is one which has the same amino acidsequence as a polypeptide (e.g., ErbB or ErbB ligand) derived fromnature. Such native sequence polypeptides can be isolated from nature orcan be produced by recombinant or synthetic means. Thus, a nativesequence polypeptide can have the amino acid sequence of naturallyoccurring human polypeptide, murine polypeptide, or polypeptide from anyother mammalian species.

The term “amino acid sequence variant” refers to polypeptides havingamino acid sequences that differ to some extent from a native sequencepolypeptide. Ordinarily, amino acid sequence variants will possess atleast about 70% homology with at least one receptor binding domain of anative ErbB ligand or with at least one ligand binding domain of anative ErbB, and preferably, they will be at least about 80%, morepreferably at least about 90% homologous with such receptor or ligandbinding domains. The amino acid sequence variants possess substitutions,deletions, and/or insertions at certain positions within the amino acidsequence of the native amino acid sequence.

“Homology” is defined as the percentage of residues in the amino acidsequence variant that are identical after aligning the sequences andintroducing gaps, if necessary, to achieve the maximum percent homology.Methods and computer programs for the alignment are well known in theart. One such computer program is “Align 2”, authored by Genentech,Inc., which was filed with user documentation in the United StatesCopyright Office, Washington, D.C. 20559, on Dec. 10, 1991.

The term “antibody” herein is used in the broadest sense andspecifically covers intact monoclonal antibodies, polyclonal antibodies,multispecific antibodies (e.g. bispecific antibodies) formed from atleast two intact antibodies, and antibody fragments, so long as theyexhibit the desired biological activity.

The term “monoclonal antibody” as used herein refers to an antibodyobtained from a population of substantially homogeneous antibodies,i.e., the individual antibodies comprising the population are identicalexcept for variants that may arise during production of the antibody.Monoclonal antibodies are highly specific, being directed against asingle antigenic site. Furthermore, in contrast to polyclonal antibodypreparations which include different antibodies directed againstdifferent determinants (epitopes), each monoclonal antibody is directedagainst a single determinant on the antigen. In addition to theirspecificity, the monoclonal antibodies are advantageous in that they maybe synthesized uncontaminated by other antibodies. The modifier“monoclonal” indicates the character of the antibody as being obtainedfrom a substantially homogeneous population of antibodies, and is not tobe construed as requiring production of the antibody by any particularmethod. For example, the monoclonal antibodies to be used in accordancewith the present invention may be made by the hybridoma method firstdescribed by Kohler et al., Nature, 256:495 (1975), or may be made byrecombinant DNA methods (see, e.g., U.S. Pat. No. 4,816,567). The“monoclonal antibodies” may also be isolated from phage antibodylibraries using the techniques described in Clackson et al., Nature,352:624-628 (1991) and Marks et al., J. Mol. Biol., 222:581-597 (1991),for example.

The monoclonal antibodies herein specifically include “chimeric”antibodies in which a portion of the heavy and/or light chain isidentical with or homologous to corresponding sequences in antibodiesderived from a particular species or belonging to a particular antibodyclass or subclass, while the remainder of the chain(s) is identical withor homologous to corresponding sequences in antibodies derived fromanother species or belonging to another antibody class or subclass, aswell as fragments of such antibodies, so long as they exhibit thedesired biological activity (U.S. Pat. No. 4,816,567; and Morrison etal., Proc. Natl. Acad. Sci. USA, 81:6851-6855 (1984)). Chimericantibodies of interest herein include “primatized” antibodies comprisingvariable domain antigen-binding sequences derived from a non-humanprimate (e.g. Old World Monkey, Ape etc) and human constant regionsequences.

“Antibody fragments” comprise a portion of an intact antibody,preferably comprising the antigen-binding or variable region thereof.Examples of antibody fragments include Fab, Fab′, F(ab′)₂, and Fvfragments; diabodies; linear antibodies; single-chain antibodymolecules; and multispecific antibodies formed from antibodyfragment(s).

An “intact” antibody is one which comprises an antigen-binding variableregion as well as a light chain constant domain (CO and heavy chainconstant domains, C_(H)1, C_(H)2 and C_(H)3. The constant domains may benative sequence constant domains (e.g. human native sequence constantdomains) or amino acid sequence variant thereof. Preferably, the intactantibody has one or more effector functions.

Antibody “effector functions” refer to those biological activitiesattributable to the Fc region (a native sequence Fc region or amino acidsequence variant Fc region) of an antibody. Examples of antibodyeffector functions include C1q binding; complement dependentcytotoxicity; Fc receptor binding; antibody-dependent cell-mediatedcytotoxicity (ADCC); phagocytosis; down regulation of cell surfacereceptors (e.g. B cell receptor; BCR), etc.

Depending on the amino acid sequence of the constant domain of theirheavy chains, intact antibodies can be assigned to different “classes”.There are five major classes of intact antibodies: IgA, IgD, IgE, IgG,and IgM, and several of these may be further divided into “subclasses”(isotypes), e.g., IgG1, IgG2, IgG3, IgG4, IgA, and IgA2. The heavy-chainconstant domains that correspond to the different classes of antibodiesare called α, δ, ε, γ, and μ, respectively. The subunit structures andthree-dimensional configurations of different classes of immunoglobulinsare well known.

“Antibody-dependent cell-mediated cytotoxicity” and “ADCC” refer to acell-mediated reaction in which nonspecific cytotoxic cells that expressFc receptors (FcRs) (e.g. Natural Killer (NK) cells, neutrophils, andmacrophages) recognize bound antibody on a target cell and subsequentlycause lysis of the target cell. The primary cells for mediating ADCC, NKcells, express FcγRIII only, whereas monocytes express FcγRI, FcγRII andFcγRIII. FcR expression on hematopoietic cells in summarized is Table 3on page 464 of Ravetch and Kinet, Annu. Rev. Immunol 9:457-92 (1991). Toassess ADCC activity of a molecule of interest, an in vitro ADCC assay,such as that described in U.S. Pat. No. 5,500,362 or 5,821,337 may beperformed. Useful effector cells for such assays include peripheralblood mononuclear cells (PBMC) and Natural Killer (NK) cells.Alternatively, or additionally, ADCC activity of the molecule ofinterest may be assessed in vivo, e.g., in a animal model such as thatdisclosed in Clynes et al. PNAS (USA) 95:652-656 (1998).

“Human effector cells” are leukocytes which express one or more FcRs andperform effector functions. Preferably, the cells express at leastFcγRIII and perform ADCC effector function. Examples of human leukocyteswhich mediate ADCC include peripheral blood mononuclear cells (PBMC),natural killer (NK) cells, monocytes, cytotoxic T cells and neutrophils;with PBMCs and NK cells being preferred. The effector cells may beisolated from a native source thereof, e.g. from blood or PBMCs asdescribed herein.

The terms “Fc receptor” or “FcR” are used to describe a receptor thatbinds to the Fc region of an antibody. The preferred FcR is a nativesequence human FcR. Moreover, a preferred FcR is one which binds an IgGantibody (a gamma receptor) and includes receptors of the FcγRI, FcγRII,and Fey RIII subclasses, including allelic variants and alternativelyspliced forms of these receptors. FcγRII receptors include FcγRIIA (an“activating receptor”) and FcγRIIB (an “inhibiting receptor”), whichhave similar amino acid sequences that differ primarily in thecytoplasmic domains thereof. Activating receptor FcγRIIA contains animmunoreceptor tyrosine-based activation motif (ITAM) in its cytoplasmicdomain. Inhibiting receptor FcγRIIB contains an immunoreceptortyrosine-based inhibition motif (ITIM) in its cytoplasmic domain. (seereview M. in Daëron, Annu. Rev. Immunol. 15:203-234 (1997)). FcRs arereviewed in Ravetch and Kinet, Annu. Rev. Immunol 9:457-92 (1991); Capelet al., Immunomethods 4:25-34 (1994); and de Haas et al., J. Lab. Clin.Med. 126:330-41 (1995). Other FcRs, including those to be identified inthe future, are encompassed by the term “FcR” herein. The term alsoincludes the neonatal receptor, FcRn, which is responsible for thetransfer of maternal IgGs to the fetus (Guyer et al., J. Immunol.117:587 (1976) and Kim et al., J. Immunol. 24:249 (1994)).

“Complement dependent cytotoxicity” or “CDC” refers to the ability of amolecule to lyse a target in the presence of complement. The complementactivation pathway is initiated by the binding of the first component ofthe complement system (C1q) to a molecule (e.g. an antibody) complexedwith a cognate antigen. To assess complement activation, a CDC assay,e.g. as described in Gazzano-Santoro et al., J. Immunol. Methods 202:163(1996), may be performed.

“Native antibodies” are usually heterotetrameric glycoproteins of about150,000 daltons, composed of two identical light (L) chains and twoidentical heavy (H) chains. Each light chain is linked to a heavy chainby one covalent disulfide bond, while the number of disulfide linkagesvaries among the heavy chains of different immunoglobulin isotypes. Eachheavy and light chain also has regularly spaced intrachain disulfidebridges. Each heavy chain has at one end a variable domain (V_(H))followed by a number of constant domains. Each light chain has avariable domain at one end (V_(L)) and a constant domain at its otherend. The constant domain of the light chain is aligned with the firstconstant domain of the heavy chain, and the light-chain variable domainis aligned with the variable domain of the heavy chain. Particular aminoacid residues are believed to form an interface between the light chainand heavy chain variable domains.

The term “variable” refers to the fact that certain portions of thevariable domains differ extensively in sequence among antibodies and areused in the binding and specificity of each particular antibody for itsparticular antigen. However, the variability is not evenly distributedthroughout the variable domains of antibodies. It is concentrated inthree segments called hypervariable regions both in the light chain andthe heavy chain variable domains. The more highly conserved portions ofvariable domains are called the framework regions (FRs). The variabledomains of native heavy and light chains each comprise four FRs, largelyadopting a β-sheet configuration, connected by three hypervariableregions, which form loops connecting, and in some cases forming part of,the β-sheet structure. The hypervariable regions in each chain are heldtogether in close proximity by the FRs and, with the hypervariableregions from the other chain, contribute to the formation of theantigen-binding site of antibodies (see Kabat et al., Sequences ofProteins of Immunological Interest, 5th Ed. Public Health Service,National Institutes of Health, Bethesda, Md. (1991)). The constantdomains are not involved directly in binding an antibody to an antigen,but exhibit various effector functions, such as participation of theantibody in antibody dependent cellular cytotoxicity (ADCC).

The term “hypervariable region” when used herein refers to the aminoacid residues of an antibody which are responsible for antigen-binding.The hypervariable region generally comprises amino acid residues from a“complementarity determining region” or “CDR” (e.g. residues 24-34 (L1),50-56 (L2) and 89-97 (L3) in the light chain variable domain and 31-35(H1), 50-65 (H2) and 95-102 (H3) in the heavy chain variable domain;Kabat et al., Sequences of Proteins of Immunological Interest, 5th Ed.Public Health Service, National Institutes of Health, Bethesda, Md.(1991)) and/or those residues from a “hypervariable loop” (e.g. residues26-32 (L1), 50-52 (L2) and 91-96 (L3) in the light chain variable domainand 26-32 (H1), 53-55 (H2) and 96-101 (H3) in the heavy chain variabledomain; Chothia and Lesk J. Mol. Biol. 196:901-917 (1987)). “FrameworkRegion” or “FR” residues are those variable domain residues other thanthe hypervariable region residues as herein defined.

Papain digestion of antibodies produces two identical antigen-bindingfragments, called “Fab” fragments, each with a single antigen-bindingsite, and a residual “Fc” fragment, whose name reflects its ability tocrystallize readily. Pepsin treatment yields an F(ab′)₂ fragment thathas two antigen-binding sites and is still capable of cross-linkingantigen.

“Fv” is the minimum antibody fragment which contains a completeantigen-recognition and antigen-binding site. This region consists of adimer of one heavy chain and one light chain variable domain in tight,non-covalent association. It is in this configuration that the threehypervariable regions of each variable domain interact to define anantigen-binding site on the surface of the V_(H)-V_(L) dimer.Collectively, the six hypervariable regions confer antigen-bindingspecificity to the antibody. However, even a single variable domain (orhalf of an Fv comprising only three hypervariable regions specific foran antigen) has the ability to recognize and bind antigen, although at alower affinity than the entire binding site.

The Fab fragment also contains the constant domain of the light chainand the first constant domain (CH1) of the heavy chain. Fab′ fragmentsdiffer from Fab fragments by the addition of a few residues at thecarboxy terminus of the heavy chain CH1 domain including one or morecysteines from the antibody hinge region. Fab′-SH is the designationherein for Fab′ in which the cysteine residue(s) of the constant domainsbear at least one free thiol group. F(ab′)₂ antibody fragmentsoriginally were produced as pairs of Fab′ fragments which have hingecysteines between them. Other chemical couplings of antibody fragmentsare also known.

The “light chains” of antibodies from any vertebrate species can beassigned to one of two clearly distinct types, called kappa (κ) andlambda (λ), based on the amino acid sequences of their constant domains.

“Single-chain Fv” or “scFv” antibody fragments comprise the V_(H) andV_(L) domains of antibody, wherein these domains are present in a singlepolypeptide chain. Preferably, the Fv polypeptide further comprises apolypeptide linker between the V_(H) and V_(L) domains which enables thescFv to form the desired structure for antigen binding. For a review ofscFv see Plückthun in The Pharmacology of Monoclonal Antibodies, vol.113, Rosenburg and Moore eds., Springer-Verlag, New York, pp. 269-315(1994). Anti-ErbB2 antibody scFv fragments are described in WO93/16185;U.S. Pat. No. 5,571,894; and U.S. Pat. No. 5,587,458.

The term “diabodies” refers to small antibody fragments with twoantigen-binding sites, which fragments comprise a variable heavy domain(V_(H)) connected to a variable light domain (V_(L)) in the samepolypeptide chain (V_(H)-V_(L)). By using a linker that is too short toallow pairing between the two domains on the same chain, the domains areforced to pair with the complementary domains of another chain andcreate two antigen-binding sites. Diabodies are described more fully in,for example, EP 404,097; WO 93/11161; and Hollinger et al., Proc. Natl.Acad. Sci. USA, 90:6444-6448 (1993).

“Humanized” forms of non-human (e.g., rodent) antibodies are chimericantibodies that contain minimal sequence derived from non-humanimmunoglobulin. For the most part, humanized antibodies are humanimmunoglobulins (recipient antibody) in which residues from ahypervariable region of the recipient are replaced by residues from ahypervariable region of a non-human species (donor antibody) such asmouse, rat, rabbit or nonhuman primate having the desired specificity,affinity, and capacity. In some instances, framework region (FR)residues of the human immunoglobulin are replaced by correspondingnon-human residues. Furthermore, humanized antibodies may compriseresidues that are not found in the recipient antibody or in the donorantibody. These modifications are made to further refine antibodyperformance. In general, the humanized antibody will comprisesubstantially all of at least one, and typically two, variable domains,in which all or substantially all of the hypervariable loops correspondto those of a non-human immunoglobulin and all or substantially all ofthe FRs are those of a human immunoglobulin sequence. The humanizedantibody optionally also will comprise at least a portion of animmunoglobulin constant region (Fc), typically that of a humanimmunoglobulin. For further details, see Jones et al., Nature321:522-525 (1986); Riechmann et al., Nature 332:323-329 (1988); andPresta, Curr. Op. Struct. Biol. 2:593-596 (1992).

Humanized anti-ErbB2 antibodies include huMAb4D5-1, huMAb4D5-2,huMAb4D5-3, huMAb4D5-4, huMAb4D5-5, huMAb4D5-6, huMAb4D5-7 andhuMAb4D5-8 (HERCEPTIN®) as described in Table 3 of U.S. Pat. No.5,821,337 expressly incorporated herein by reference; humanized 520C9(WO93/21319) and humanized 2C4 antibodies as described hereinbelow.

An “isolated” antibody is one which has been identified and separatedand/or recovered from a component of its natural environment.Contaminant components of its natural environment are materials whichwould interfere with diagnostic or therapeutic uses for the antibody,and may include enzymes, hormones, and other proteinaceous ornonproteinaceous solutes. In preferred embodiments, the antibody will bepurified (1) to greater than 95% by weight of antibody as determined bythe Lowry method, and most preferably more than 99% by weight, (2) to adegree sufficient to obtain at least 15 residues of N-terminal orinternal amino acid sequence by use of a spinning cup sequenator, or (3)to homogeneity by SDS-PAGE under reducing or nonreducing conditionsusing Coomassie blue or, preferably, silver stain. Isolated antibodyincludes the antibody in situ within recombinant cells since at leastone component of the antibody's natural environment will not be present.Ordinarily, however, isolated antibody will be prepared by at least onepurification step.

An antibody “which binds” an antigen of interest, e.g. ErbB2 antigen, isone capable of binding that antigen with sufficient affinity such thatthe antibody is useful as a therapeutic agent in targeting a cellexpressing the antigen. Where the antibody is one which binds ErbB2, itwill usually preferentially bind ErbB2 as opposed to other ErbBs, andmay be one which does not significantly cross-react with other proteinssuch as EGFR, ErbB3 or ErbB4. In such embodiments, the extent of bindingof the antibody to these non-ErbB2 proteins (e.g., cell surface bindingto endogenous receptor) will be less than 10% as determined byfluorescence activated cell sorting (FACS) analysis orradioimmunoprecipitation (RIA). Sometimes, the anti-ErbB2 antibody willnot significantly cross-react with the rat neu protein, e.g., asdescribed in Schecter et al. Nature 312:513 (1984) and Drebin et al.,Nature 312:545-548 (1984).

An antibody which “blocks” ligand activation of an ErbB is one whichreduces or prevents such activation as hereinabove defined, wherein theantibody is able to block ligand activation of the ErbB substantiallymore effectively than monoclonal antibody 4D5, e.g. about as effectivelyas monoclonal antibodies 7F3 or 2C4 or Fab fragments thereof andpreferably about as effectively as monoclonal antibody 2C4 or a Fabfragment thereof. For example, the antibody that blocks ligandactivation of an ErbB may be one which is about 50-100% more effectivethan 4D5 at blocking formation of an ErbB hetero-oligomer. Blocking ofligand activation of an ErbB can occur by any means, e.g. by interferingwith: ligand binding to an ErbB, ErbB complex formation, tyrosine kinaseactivity of an ErbB in an ErbB complex and/or phosphorylation oftyrosine kinase residue(s) in or by an ErbB. Examples of antibodieswhich block ligand activation of an ErbB include monoclonal antibodies2C4 and 7F3 (which block HRG activation of ErbB2/ErbB3 and ErbB2/ErbB4hetero-oligomers; and EGF, TGF-α, amphiregulin, HB-EGF and/or epiregulinactivation of an EGFR/ErbB2 hetero-oligomer); and L26, L96 and L288antibodies (Klapper et al. Oncogene 14:2099-2109 (1997)), which blockEGF and NDF binding to T47D cells which express EGFR, ErbB2, ErbB3 andErbB4.

An antibody having a “biological characteristic” of a designatedantibody, such as the monoclonal antibody designated 2C4, is one whichpossesses one or more of the biological characteristics of that antibodywhich distinguish it from other antibodies that bind to the same antigen(e.g. ErbB2). For example, an antibody with a biological characteristicof 2C4 may block HRG activation of an ErbB hetero-oligomer comprisingErbB2 and ErbB3 or ErbB4; block EGF, TGF-α HB-EGF, epiregulin and/oramphiregulin activation of an ErbB comprising EGFR and ErbB2; block EGF,TGF-α and/or HRG mediated activation of MAPK; and/or bind the sameepitope in the extracellular domain of ErbB2 as that bound by 2C4 (e.g.which blocks binding of monoclonal antibody 2C4 to ErbB2).

Unless indicated otherwise, the expression “monoclonal antibody 2C4”refers to an antibody that has antigen binding residues of, or derivedfrom, the murine 2C4 antibody of the Examples below. For example, themonoclonal antibody 2C4 may be murine monoclonal antibody 2C4 or avariant thereof, such as humanized antibody 2C4, possessing antigenbinding amino acid residues of murine monoclonal antibody 2C4. Examplesof humanized 2C4 antibodies are provided in Example 3 below. Unlessindicated otherwise, the expression “rhuMAb 2C4” when used herein refersto an antibody comprising the variable light (V_(L)) and variable heavy(V_(H)) sequences of SEQ ID Nos. 3 and 4, respectively, fused to humanlight and heavy IgG1 (non-A allotype) constant region sequencesoptionally expressed by a Chinese Hamster Ovary (CHO) cell.

Unless indicated otherwise, the term “monoclonal antibody 4D5” refers toan antibody that has antigen binding residues of, or derived from, themurine 4D5 antibody (ATCC CRL 10463). For example, the monoclonalantibody 4D5 may be murine monoclonal antibody 4D5 or a variant thereof,such as a humanized 4D5, possessing antigen binding residues of murinemonoclonal antibody 4D5. Exemplary humanized 4D5 antibodies includehuMAb4D5-1, huMAb4D5-2, huMAb4D5-3, huMAb4D5-4, huMAb4D5-5, huMAb4D5-6,huMAb4D5-7 and huMAb4D5-8 (HERCEPTIN®) as in U.S. Pat. No. 5,821,337,with huMAb4D5-8 (HERCEPTIN®) being a preferred humanized 4D5 antibody.

A “growth inhibitory agent” when used herein refers to a compound orcomposition which inhibits growth of a cell, especially an ErbBexpressing cell either in vitro or in vivo. Thus, the growth inhibitoryagent may be one which significantly reduces the percentage of ErbBexpressing cells in S phase. Examples of growth inhibitory agentsinclude agents that block cell cycle progression (at a place other thanS phase), such as agents that induce G1 arrest and M-phase arrest.Classical M-phase blockers include the vincas (vincristine andvinblastine), taxanes, and topo II inhibitors such as doxorubicin,epirubicin, daunorubicin, etoposide, and bleomycin. Those agents thatarrest G1 also spill over into S-phase arrest, for example, DNAalkylating agents such as tamoxifen, prednisone, dacarbazine,mechlorethamine, cisplatin, methotrexate, 5-fluorouracil, and ara-C.Further information can be found in The Molecular Basis of Cancer,Mendelsohn and Israel, eds., Chapter 1, entitled “Cell cycle regulation,oncogenes, and antineoplastic drugs” by Murakami et al. (WB Saunders:Philadelphia, 1995), especially p. 13.

Examples of “growth inhibitory” antibodies are those which bind to ErbB2and inhibit the growth of cells overexpressing ErbB2. Preferred growthinhibitory anti-ErbB2 antibodies inhibit growth of SK-BR-3 breast tumorcells in cell culture by greater than 20%, and preferably greater than50% (e.g. from about 50% to about 100%) at an antibody concentration ofabout 0.5 to 30 μg/ml, where the growth inhibition is determined sixdays after exposure of the SK-BR-3 cells to the antibody (see U.S. Pat.No. 5,677,171 issued Oct. 14, 1997). The SK-BR-3 cell growth inhibitionassay is described in more detail in that patent and hereinbelow. Thepreferred growth inhibitory antibody is monoclonal antibody 4D5, e.g.,humanized 4D5.

An antibody which “induces cell death” is one which causes a viable cellto become nonviable. The cell is generally one which expresses the ErbB2receptor, especially where the cell overexpresses the ErbB2 receptor.Preferably, the cell is a cancer cell, e.g. a breast, ovarian, stomach,endometrial, salivary gland, lung, kidney, colon, thyroid, pancreatic orbladder cell. In vitro, the cell may be a SK-BR-3, BT474, Calu 3,MDA-MB-453, MDA-MB-361 or SKOV3 cell. Cell death in vitro may bedetermined in the absence of complement and immune effector cells todistinguish cell death induced by antibody-dependent cell-mediatedcytotoxicity (ADCC) or complement dependent cytotoxicity (CDC). Thus,the assay for cell death may be performed using heat inactivated serum(i.e. in the absence of complement) and in the absence of immuneeffector cells. To determine whether the antibody is able to induce celldeath, loss of membrane integrity as evaluated by uptake of propidiumiodide (PI), trypan blue (see Moore et al. Cytotechnology 17:1-11(1995)) or 7AAD can be assessed relative to untreated cells. Preferredcell death-inducing antibodies are those which induce PI uptake in thePI uptake assay in BT474 cells (see below).

An antibody which “induces apoptosis” is one which induces programmedcell death as determined by binding of annexin V, fragmentation of DNA,cell shrinkage, dilation of endoplasmic reticulum, cell fragmentation,and/or formation of membrane vesicles (called apoptotic bodies). Thecell is usually one which overexpresses the ErbB2 receptor. Preferablythe cell is a tumor cell, e.g. a breast, ovarian, stomach, endometrial,salivary gland, lung, kidney, colon, thyroid, pancreatic or bladdercell. In vitro, the cell may be a SK-BR-3, BT474, Calu 3 cell,MDA-MB-453, MDA-MB-361 or SKOV3 cell. Various methods are available forevaluating the cellular events associated with apoptosis. For example,phosphatidyl serine (PS) translocation can be measured by annexinbinding; DNA fragmentation can be evaluated through DNA laddering; andnuclear/chromatin condensation along with DNA fragmentation can beevaluated by any increase in hypodiploid cells. Preferably, the antibodywhich induces apoptosis is one which results in about 2 to 50 fold,preferably about 5 to 50 fold, and most preferably about 10 to 50 fold,induction of annexin binding relative to untreated cell in an annexinbinding assay using BT474 cells (see below). Sometimes the pro-apoptoticantibody will be one which further blocks ErbB ligand activation of anErbB (e.g. 7F3 antibody); i.e. the antibody shares a biologicalcharacteristic with monoclonal antibody 2C4. In other situations, theantibody is one which does not significantly block ErbB ligandactivation of an ErbB (e.g. 7C2). Further, the antibody may be one like7C2 which, while inducing apoptosis, does not induce a large reductionin the percent of cells in S phase (e.g. one which only induces about0-10% reduction in the percent of these cells relative to control).

The “epitope 2C4” is the region in the extracellular domain of ErbB2 towhich the antibody 2C4 binds. In order to screen for antibodies whichbind to the 2C4 epitope, a routine cross-blocking assay such as thatdescribed in Antibodies, A Laboratory Manual, Cold Spring HarborLaboratory, Ed Harlow and David Lane (1988), can be performed.Alternatively, epitope mapping can be performed to assess whether theantibody binds to the 2C4 epitope of ErbB2 (e.g. any one or moreresidues in the region from about residue 22 to about residue 584 ofErbB2, inclusive; see FIGS. 1A-B).

The “epitope 4D5” is the region in the extracellular domain of ErbB2 towhich the antibody 4D5 (ATCC CRL 10463) binds. This epitope is close tothe transmembrane domain of ErbB2. To screen for antibodies which bindto the 4D5 epitope, a routine cross-blocking assay such as thatdescribed in Antibodies, A Laboratory Manual, Cold Spring HarborLaboratory, Ed Harlow and David Lane (1988), can be performed.Alternatively, epitope mapping can be performed to assess whether theantibody binds to the 4D5 epitope of ErbB2 (e.g. any one or moreresidues in the region from about residue 529 to about residue 625,inclusive; see FIGS. 1A-B).

The “epitope 3H4” is the region in the extracellular domain of ErbB2 towhich the antibody 3H4 binds. This epitope includes residues from about541 to about 599, inclusive, in the amino acid sequence of ErbB2extracellular domain; see FIGS. 1A-B.

The “epitope 7C2/7F3” is the region at the N terminus of theextracellular domain of ErbB2 to which the 7C2 and/or 7F3 antibodies(each deposited with the ATCC, see below) bind. To screen for antibodieswhich bind to the 7C2/7F3 epitope, a routine cross-blocking assay suchas that described in Antibodies, A Laboratory Manual, Cold Spring HarborLaboratory, Ed Harlow and David Lane (1988), can be performed.Alternatively, epitope mapping can be performed to establish whether theantibody binds to the 7C2/7F3 epitope on ErbB2 (e.g. any one or more ofresidues in the region from about residue 22 to about residue 53 ofErbB2; see FIGS. 1A-B).

An “ErbB-expressing cell” is one which has ErbB protein present at itscell surface, such that an anti-ErbB2 antibody can bind thereto.

A cell “characterized by excessive activation” of an ErbB is one inwhich the extent of ErbB activation therein significantly exceeds thelevel of activation of that receptor in a normal cell of the same tissuetype. Such excessive activation may result from overexpression oramplification of the ErbB and/or greater than normal levels of an ErbBligand available for activating the ErbB in the cell. Such excessiveactivation may cause and/or be caused by a diseased state of the cell.In some embodiments, a sample from the patient will be subjected to adiagnostic or prognostic assay to determine whether amplification and/oroverexpression of an ErbB is occurring which results in such excessiveactivation of the ErbB. Alternatively, or additionally, a sample fromthe patient may be subjected to a diagnostic or prognostic assay todetermine whether amplification, overexpression and/or increasedproteolytic processing of an ErbB ligand is occurring in the patientwhich attributes to excessive activation of the receptor. Sometimes,excessive activation of the receptor may result from an autocrinestimulatory pathway.

In an “autocrine” stimulatory pathway, self stimulation occurs by virtueof the cell producing both an ErbB ligand and its cognate ErbB. Forexample, the cell may express or overexpress EGFR and also express oroverexpress an EGFR ligand (e.g. EGF, TGF-α, or HB-EGF). In anotherembodiment, the cell may express or overexpress ErbB2 and also expressor overexpress a heregulin (e.g. γ-HRG).

A cell which “overexpresses” an ErbB is one which has significantlyhigher levels of an ErbB, such as ErbB2, at the cell surface thereof,compared to a normal cell of the same tissue type. Such overexpressionmay be caused by gene amplification or by increased transcription ortranslation. ErbB overexpression may be determined in a diagnostic orprognostic assay by evaluating increased levels of the ErbB proteinpresent on the surface of a cell (e.g. via an immunohistochemistryassay; IHC, immunoenzyme, Western blot, ligand binding, kinaseactivity). Alternatively, or additionally, one may measure levels ofErbB-encoding nucleic acid in the cell, e.g. via fluorescent in situhybridization (FISH; see WO98/45479 published October, 1998), southernblotting, or polymerase chain reaction (PCR) techniques, such as realtime quantitative PCR (RT-PCR). One may also study ErbB overexpressionby measuring shed antigen (e.g., ErbB extracellular domain) in abiological fluid such as serum (see, e.g., U.S. Pat. No. 4,933,294issued Jun. 12, 1990; WO91/05264 published Apr. 18, 1991; U.S. Pat. No.5,401,638 issued Mar. 28, 1995; and Sias et al. J. Immunol. Methods 132:73-80 (1990)). Aside from the above assays, various in vivo assays areavailable to the skilled practitioner. For example, one may expose cellswithin the body of the patient to an antibody which is optionallylabeled with a detectable label, e.g. a radioactive isotope, and bindingof the antibody to cells in the patient can be evaluated, e.g. byexternal scanning for radioactivity or by analyzing a biopsy taken froma patient previously exposed to the antibody.

Conversely, a cell which is “not characterized by overexpression of anErbB” is one which, in a diagnostic assay, does not express higher thannormal levels of ErbB compared to a normal cell of the same tissue type.

A cell which “overexpresses” an ErbB ligand is one which producessignificantly higher levels of that ligand compared to a normal cell ofthe same tissue type. Such overexpression may be caused by geneamplification or by increased transcription or translation.Overexpression of the ErbB ligand may be determined diagnostically byevaluating levels of the ligand (or nucleic acid encoding it) in thepatient, e.g. in a biopsy or by various diagnostic assays such as theIHC, immunoenzyme, Western blot, ligand binding, FISH, southernblotting, PCR or in vivo assays described above.

The term “cytotoxic agent” as used herein refers to a substance thatinhibits or prevents the function of cells and/or causes destruction ofcells. The term is intended to include radioactive isotopes (e.g. At²¹¹,I¹³¹, I¹²⁵, Y⁹⁰, Re¹⁸⁶, Re¹⁸⁸, Sm¹⁵³, Bi²¹², P³² and radioactiveisotopes of Lu), chemotherapeutic agents, and toxins such as smallmolecule toxins or enzymatically active toxins of bacterial, fungal,plant or animal origin, including fragments and/or variants thereof.

A “chemotherapeutic agent” is a chemical compound useful in thetreatment of cancer. Examples of chemotherapeutic agents includealkylating agents such as thiotepa and cyclosphosphamide (CYTOXAN®);alkyl sulfonates such as busulfan, improsulfan and piposulfan;aziridines such as benzodopa, carboquone, meturedopa, and uredopa;ethylenimines and methylamelamines including altretamine,triethylenemelamine, trietylenephosphoramide,triethylenethiophosphaoramide and trimethylolomelamine; nitrogenmustards such as chlorambucil, chlornaphazine, cholophosphamide,estramustine, ifosfamide, mechlorethamine, mechlorethamine oxidehydrochloride, melphalan, novembichin, phenesterine, prednimustine,trofosfamide, uracil mustard; nitrosureas such as carmustine,chlorozotocin, fotemustine, lomustine, nimustine, ranimustine;antibiotics such as aclacinomysins, actinomycin, authramycin, azaserine,bleomycins, cactinomycin, calicheamicin, carabicin, caminomycin,carzinophilin, chromomycins, dactinomycin, daunorubicin, detorubicin,6-diazo-5-oxo-L-norleucine, doxorubicin, epirubicin, esorubicin,idarubicin, marcellomycin, mitomycins, mycophenolic acid, nogalamycin,olivomycins, peplomycin, potfiromycin, puromycin, quelamycin,rodorubicin, streptonigrin, streptozocin, tubercidin, ubenimex,zinostatin, zorubicin; anti-metabolites such as methotrexate and5-fluorouracil (5-FU); folic acid analogues such as denopterin,methotrexate, pteropterin, trimetrexate; purine analogs such asfludarabine, 6-mercaptopurine, thiamiprine, thioguanine; pyrimidineanalogs such as ancitabine, azacitidine, 6-azauridine, carmofur,cytarabine, dideoxyuridine, doxifluridine, enocitabine, floxuridine,5-FU; androgens such as calusterone, dromostanolone propionate,epitiostanol, mepitiostane, testolactone; anti-adrenals such asaminoglutethimide, mitotane, trilostane; folic acid replenisher such asfrolinic acid; aceglatone; aldophosphamide glycoside; aminolevulinicacid; amsacrine; bestrabucil; bisantrene; edatraxate; defofamine;demecolcine; diaziquone; elformithine; elliptinium acetate; etoglucid;gallium nitrate; hydroxyurea; lentinan; lonidamine; mitoguazone;mitoxantrone; mopidamol; nitracrine; pentostatin; phenamet; pirarubicin;podophyllinic acid; 2-ethylhydrazide; procarbazine; PSK®; razoxane;sizofuran; spirogermanium; tenuazonic acid; triaziquone; 2,2′,2″-trichlorotriethylamine; urethan; vindesine; dacarbazine;mannomustine; mitobronitol; mitolactol; pipobroman; gacytosine;arabinoside (“Ara-C”); cyclophosphamide; thiotepa; taxanes, e.g.paclitaxel (TAXOL®, Bristol-Myers Squibb Oncology, Princeton, N.J.) anddocetaxel (TAXOTERE®, Rhône-Poulenc Rorer, Antony, France);chlorambucil; gemcitabine; 6-thioguanine; mercaptopurine; methotrexate;platinum analogs such as cisplatin and carboplatin; vinblastine;platinum; etoposide (VP-16); ifosfamide; mitomycin C; mitoxantrone;vincristine; vinorelbine; navelbine; novantrone; teniposide; daunomycin;aminopterin; xeloda; ibandronate; CPT-11; topoisomerase inhibitor RFS2000; difluoromethylomithine (DMFO); retinoic acid; esperamicins;capecitabine; and pharmaceutically acceptable salts, acids orderivatives of any of the above. Also included in this definition areanti-hormonal agents that act to regulate or inhibit hormone action oncells such as anti-estrogens including for example tamoxifen,raloxifene, aromatase inhibiting 4(5)-imidazoles, 4-hydroxytamoxifen,trioxifene, keoxifene, LY117018, onapristone, and toremifene (Fareston);and anti-androgens such as flutamide, nilutamide, bicalutamide,leuprolide, and goserelin; and pharmaceutically acceptable salts, acidsor derivatives of any of the above.

An “anti-angiogenic agent” refers to a compound which blocks, orinterferes with to some degree, the development of blood vessels. Theanti-angiogenic factor may, for instance, be a small molecule orantibody that binds to a growth factor or growth factor receptorinvolved in promoting angiogenesis. The preferred anti-angiogenic factorherein is an antibody that binds to Vascular Endothelial Growth Factor(VEGF), such as the recombinant humanized anti-VEGF antibody AVASTIN®(Genentech).

The term “cytokine” is a generic term for proteins released by one cellpopulation which act on another cell as intercellular mediators.Examples of such cytokines are lymphokines, monokines, and traditionalpolypeptide hormones. Included among the cytokines are growth hormonesuch as human growth hormone, N-methionyl human growth hormone, andbovine growth hormone; parathyroid hormone; thyroxine; insulin;proinsulin; relaxin; prorelaxin; glycoprotein hormones such as folliclestimulating hormone (FSH), thyroid stimulating hormone (TSH), andluteinizing hormone (LH); hepatic growth factor; fibroblast growthfactor; prolactin; placental lactogen; tumor necrosis factor-α and -β;mullerian-inhibiting substance; mouse gonadotropin-associated peptide;inhibin; activin; vascular endothelial growth factor; integrin;thrombopoietin (TPO); nerve growth factors such as NGF-β;platelet-growth factor; transforming growth factors (TGFs) such as TGF-αand TGF-β; insulin-like growth factor-I and -II; erythropoietin (EPO);osteoinductive factors; interferons such as interferon-α, -β, and -γ,colony stimulating factors (CSFs) such as macrophage-CSF (M-CSF);granulocyte-macrophage-CSF (GM-CSF); and granulocyte-CSF (G-CSF);interleukins (Ms) such as IL-1, IL-1α, IL-2, IL-3, IL-4, IL-5, IL-6,IL-7, IL-8, IL-9, IL-10, IL-11, IL-12; a tumor necrosis factor such asTNF-α or TNF-β; and other polypeptide factors including LIF and kitligand (KL). As used herein, the term cytokine includes proteins fromnatural sources or from recombinant cell culture and biologically activeequivalents of the native sequence cytokines.

The term “package insert” is used to refer to instructions customarilyincluded in commercial packages of therapeutic products, that containinformation about the indications, usage, dosage, administration,contraindications and/or warnings concerning the use of such therapeuticproducts.

A “cardioprotectant” is a compound or composition which prevents orreduces myocardial dysfunction (i.e. cardiomyopathy and/or congestiveheart failure) associated with administration of a drug, such as ananthracycline antibiotic and/or an anti-ErbB2 antibody, to a patient.The cardioprotectant may, for example, block or reduce afree-radical-mediated cardiotoxic effect and/or prevent or reduceoxidative-stress injury. Examples of cardioprotectants encompassed bythe present definition include the iron-chelating agent dexrazoxane(ICRF-187) (Seifert et al. The Annals of Pharmacotherapy 28:1063-1072(1994)); a lipid-lowering agent and/or anti-oxidant such as probucol(Singal et al. J. Mol. Cell. Cardiol. 27:1055-1063 (1995)); amifostine(aminothiol 2-[(3-aminopropyl)amino]ethanethiol-dihydrogen phosphateester, also called WR-2721, and the dephosphorylated cellular uptakeform thereof called WR-1065) andS-3-(3-methylaminopropylamino)propylphosphorothioic acid (WR-151327),see Green et al. Cancer Research 54:738-741 (1994); digoxin (Bristow, M.R. In: Bristow M R, ed. Drug-Induced Heart Disease. New York: Elsevier191-215 (1980)); beta-blockers such as metoprolol (Hjalmarson et al.Drugs 47:Suppl 4:31-9 (1994); and Shaddy et al. Am. Heart J. 129:197-9(1995)); vitamin E; ascorbic acid (vitamin C); free radical scavengerssuch as oleanolic acid, ursolic acid and N-acetylcysteine (NAC); spintrapping compounds such as alpha-phenyl-tert-butyl nitrone (PBN);(Paracchini et al., Anticancer Res. 13:1607-1612 (1993)); selenoorganiccompounds such as P251 (Elbesen); and the like.

II. DETAILED DESCRIPTION

The ErbB (HER) family of transmembrane tyrosine kinase receptors iscomposed of four members, ErbB1 (HER1, EGFR); ErbB2 (HER2 orp185^(neu)), ErbB3 (HER3) and ErbB4 (HER4 or tyro2).

ErbB2/HER2/p185^(neu) and ErbB1/EGFR are significantly over-expressed inmost epithelial malignancies, including breast cancer, head and neckcancer, stomach cancer, prostate cancer, ovarian cancer, pancreaticcancer, lung cancer bladder, as well as glioblastomas. HER2 amplifiesthe signal provided by other receptors of the HER family by formingheterodimers. The essential role of HER2 in the HER signaling networkled to the development of anti-HER2 monoclonal antibodies (MAbs) forcancer therapy. In particular, a humanized anti-ErbB2 MAb (transtuzumab,Herceptin®, Genentech, Inc.) is widely used for the treatment of womenwith HER2 overexpressing breast cancers. Trastuzumab induces HER2receptor downmodulation and, as a result, inhibits critical signallingpathways (i.e. ras-Raf-MAPK and PI3K/Akt) and blocks cell cycleprogression by inducing the formation of p27/Cdk2 complexes. Trastuzumabalso inhibits HER2 cleavage, preceding antibody-induced receptordownmodulation, which effect might contribute to its antitumor activityin some cancers. In vivo, trastuzumab inhibits angiogenesis and inducesantibody-dependent cellular cytotoxicity. HER2 is known to formheterodimers with HER1 (EGFR), HER3 or HER4. A humanized monoclonalantibody, called 2C4, is in clinical development for cancer treatment.2C4 binds to a different epitope of HER2 ectodomain than trastuzumab andsterically hinders HER2 recruitment in heterodimers with other HERreceptors. This results in the inhibition of signalling by HER2-basedheterodimers both in cells with low and high HER2 expression. In vitroand in vivo antitumor activity has been reported in a range of breastand prostate tumor models. Small-molecule anti-HER2/neu peptidomimetics(ARNP) have also been developed and tested for efficacy in cancertherapy (Zhang et al., Drug News Perspect. 13(6):325-9 (2000).

The present invention is, at least partially, based on the unexpectedfinding that ErbB antagonists exhibit analgesic effects and are,therefore, useful in the management of pain, including chronic pain,such as cancer-related pain. In particular, prostate cancer patientstreated with the humanized anti-ErbB2 antibody 2C4 recorded less painand reduced analgesia even when their PSA value was not reduced.Similarly, the analgesic effect of the humanized 2C4 antibody wasobserved during the treatment of liposarcoma.

Therefore, in its broadest aspect, the invention relates to painmanagement using ErbB antagonists. In particular, the invention concernsthe management of pain, including acute and chronic pain, either cancerrelated or not associated with cancer, with ErbB antagonists. Theinvention concerns the treatment of any type of pain, including, withoutlimitation, nociceptive pain, somatic pain, visceral pain, neuropathicpain, centrally generated pain (including deafferentiation pain andsympathetically maintained pain), and peripherally generated pain(including painful polyneuropathies and painful mononeuropethies).

ErbB Antagonists

The ErbB antagonists of the present invention are molecules that block(reduce or prevent) a biological activity of one or more ErbB(s).Preferably, the antagonist blocks (reduces or prevents) ligandactivation of an ErbB. In a particular embodiment, the ErbB antagonistsof the present invention inhibit a biological activity mediated by anErbB2 (HER2) and/or ErbB1 (EGFR) receptor or a receptor complexcomprising such receptor(s).

The ErbB antagonists herein include, without limitation, polypeptides(including antibodies and antibody fragments), peptides, peptidemimetics, non-peptide small organic molecules, antisense molecules, andoligonucleotide decoy molecules.

Small organic molecules that compete with ATP binding to the kinasepocket of EGFR are reviewed, for example, by Arteaga CL., Exp. Cell.Res. 284(1):122-30 (2003). A small molecule EGFR inhibitor, Iressa™(ZD1839, gefinitib, Aztra-Zeneca) is described, for example, in Kris Met al. JAMA, 290(16):2149-2158 (2003). Further small molecule EGFRantagonists include CP-358,774 (TARCEVA; Genentech/OSI) and AG1478,AG1571 (SU 5271; Sugen).

Anti-EGFR antibodies are also known in the art and include, for example,Erbitux® (IMC-C225, cetuximab, ImClone) a chimeric anti-EGFR MAb, andreshaped human 225 (H225) (see, WO 96/40210, ImClone Systems Inc.).Further examples of antibodies which bind to EGFR include MAb 579 (ATCCCRL HB. 8506), MAb 455 (ATCC CRL HB8507), MAb 225 (ATCC CRL 8508), MAb528 (ATCC CRL 8509) (see, U.S. Pat. No. 4,943,533, Mendelsohn et al.)and variants thereof, humanized and chimeric antibodies that bind EGFRas described in U.S. Pat. No. 5,891,996, and human antibodies that bindEGFR, such as ABX-EGF (see WO98/50433, Abgenix). The anti-EGFR antibodymay be conjugated with a cytotoxic agent, thus generating animmunoconjugate (see, e.g., EP659,439A2, Merck Patent GmbH).

CP-654577 (Pfizer) a selective inhibitor of ErbB2 relative to EGFRtyrosine kinase, is disclosed, for example, in Barbacci et al., CancerRes. 63(15):4450-9 (2003). A small molecule form of anti-ErbB2peptidomimetic is described by Zhang et al., Drug Nes Perspect13(6):325-9 (2000).

Identification of ErbB Antagonists

New agents that target and inhibit a biological activity of ErbBreceptors, such as EGFR and/or ErbB2, can be identified by methods knownin the art.

In general, the first step in identifying new ErbB antagonists is invitro screening followed by in vivo assays in an appropriate animalmodel and ultimately human clinical trials.

To identify compounds that bind to an ErbB receptor or receptor complex,receptor-binding tests can be performed using ErbB receptors or receptorcomplexes isolated from their respective native sources, or produced byrecombinant DNA technology and/or chemical synthesis. The bindingaffinity of the candidate compounds can be tested by direct binding orby indirect, e.g. competitive, binding. In competitive bindingexperiments, the concentration of a compound necessary to displace 50%of another compound bound to the receptor (IC₅₀) is usually used as ameasure of binding affinity.

In another method, in order to identify novel ErbB antagonists, DNAencoding the sequence encoding the target ErbB receptor (e.g. ErbB2 orEGFR) is cloned into an expression vector containing a selectablemarker. The vector is used to transfect recombinant host cells.Following several rounds of selection stable lines which express theErbB receptor are identified. New ErbB antagonists can then beidentified by virtue of their ability to compete effectively with aknown inhibitor of the target ErbB receptor. Binding coefficients can bedetermined by any known manner, e.g. by Scatchard analysis.

Binding experiments can also be performed using cells or cell linesknown to express the target ErbB receptor.

To identify a candidate molecule which blocks ligand activation of anErbB, the ability of the molecule to block ErbB ligand binding to cellsexpressing the ErbB (e.g. in conjugation with another ErbB with whichthe ErbB of interest forms an ErbB hetero-oligomer) may be determined.For example, cells naturally expressing, or transfected to express,ErbBs of the ErbB hetero-oligomer may be incubated with the candidatemolecule and then exposed to labeled ErbB ligand. The ability of thecandidate molecule to block ligand binding to the ErbB in the ErbBhetero-oligomer may then be evaluated.

Alternatively, or additionally, the ability of a candidate molecule toblock ErbB ligand-stimulated tyrosine phosphorylation of an ErbB presentin an ErbB hetero-oligomer may be assessed. For example, cellsendogenously expressing the ErbBs or transfected to expressed them maybe incubated with the candidate molecule and then assayed for ErbBligand-dependent tyrosine phosphorylation activity using ananti-phosphotyrosine monoclonal (which is optionally conjugated with adetectable label). The kinase receptor activation assay described inU.S. Pat. No. 5,766,863 is also available for determining ErbBactivation and blocking of that activity by an antagonist.

One may also assess the growth inhibitory effects of a candidatemolecule on MDA-MB-175 cells, e.g, essentially as described in Schaeferet al. Oncogene 15:1385-1394 (1997). According to this assay, MDA-MB-175cells may treated with a candidate antagonist and stained with crystalviolet. Incubation with a candidate antagonist may show a growthinhibitory effect on this cell line similar to that displayed bymonoclonal antibody 2C4. In a further embodiment, exogenous HRG will notsignificantly reverse this inhibition. Preferably, the antagonist willbe able to inhibit cell proliferation of MDA-MB-175 cells to a greaterextent than monoclonal antibody 4D5 (and optionally to a greater extentthan monoclonal antibody 7F3), both in the presence and absence ofexogenous HRG.

In one embodiment, the antagonist may block heregulin dependentassociation of ErbB2 with ErbB3 in both MCF7 and SK-BR-3 cells asdetermined in a co-immunoprecipitation experiment such as that describedin Example 2 substantially more effectively than monoclonal antibody4D5, and preferably substantially more effectively than monoclonalantibody 7F3.

To identify antagonists with growth inhibitory properties, one mayscreen for antibodies which inhibit the growth of cancer cells whichoverexpress ErbB2.

To select for antagonists which induce cell death, loss of membraneintegrity as indicated by, e.g., PI, trypan blue or 7AAD uptake may beassessed relative to control. The preferred assay is the PI uptake assayusing BT474 cells. Details of this assay will be provided hereinafter,with particular reference to antibodies.

In order to select for antagonists which induce apoptosis, for examplean annexin binding assay using BT474 cells or a DNA staining assay usingBT 474 cells can be used, These assays will be described in detailhereinbelow, with reference to antibodies with apoptotic properties.

According to a further approach, ErbB2 and EGFR antagonists areidentified by correlating EGFR, TGF-α (a ligand for EGFR), and ErbB2mRNA expression levels with the results of cytotoxicity assays of the49000 compounds in the National Cancer Institute (NCI) drug screendatabase (Wosikowski et al., J. Natl. Cancer Inst. 89(20):1505-15(1997)).

After determining the inhibition of a target biological activity in anin vitro assay, the ability of a candidate antagonist to control paincan be tested in in vivo models of pain.

In a preferred embodiment, the analgesic activity of a candidate ErbBantagonist is tested in an animal model used in pain research.

Animal Models of Pain

(i) Noxious Pain

A suitable animal model of noxious pain is the “tail flick” test (Bassand Wanderbrook, J. Am. Pharm. Assoc. Sci. Ed. 41:569-70 (1952)) Thismethod is based on measuring pain sensitivity in mice or rats as theyrespond to the application of heat to a small area of their tails withor without administration of a candidate ErbB antagonist. The test isbased on measuring the withdrawal time of the tail following applicationof radiant heat, and can be performed by using commercially availableequipment, such as, for example, the Tail Flick Analgesia Meter (SDI,San Diego, Calif.).

Another animal model of noxious pain is the “hot plate paw-licking”test. In this test, animals (rats or mice) are individually placed on ahot plate. The latency to first sign of hind paw licking is taken orjump response is taken as an index of nociceptive threshold. The effectof drug administration on this threshold is considered to be an index ofanalgesic response. (O'Callaghan and Holzman, J. Pharmaceol. Exp. Ther.192:497-505 (1975)). The route of drug administration may differ buttypically is subcutaneous.

The paw-pressure, or mechanical hyperalgesia, test uses a pressure ofincreasing intensity applied to a punctiform area on the hindpaw or,less commonly, on the tail. In practice, the paw or tail is placedbetween a plane surface and a blunt, plastic-coated point mounted on topof a system of cogwheels, with a cursor that can be displaced along thelength of a graduated beam (Green et al., Br. J. Pharmacol. 6:572-85(1957) for an automated readout. The application of increasing pressureis interrupted when the animal removes its tail, an action that is readout as force in grams for the threshold of response.

Chemical stimuli can also be used to model noxious pain in animals.Typically the chemical agents are administered intradermally orintraperitoneally. For example, in the formalin (paw) test usually a 0.5to 15% (generally about 3.5%) solution of formalin is injected into thedorsal or plantar surface of the rat fore- or hindpaw, and produces apainful response of increasing and decreasing intensity for about 60minutes. Typical responses include paw lifting, licking, nibbling orshaking, which can be monitored in the absence and presence of a testsubstance (Lariviere and Melzack, Pain 66:271-7 (1996)).

(ii) Visceral Pain

Visceral pain is typically tested by intraperitoneal injections ofirritants (Writhing Test), such as, for example, acetic acid/ethacrinicacid or phenylbenzoquinone. The agents provoke a stereotypical responsein rodents, characterized by abdominal contractions, whol ebodymovements, contortions of the abdominal muscles, reduced motor activityand incoordination. These responses are considered indicative ofvisceral pain associated with visceral chemoreceptors. The writhing testhas been successfully used to predict effective analgesic doses fortreatment of humans (Dubinsky et al., Agents Actions 20:50-60 (1987)).

(iii) Inflammatory Pain

Inflammatory pain is typically modeled using p-benzoquinone-inducedWrithing Test or the carrageean-induced hind paw edema model (DiRosa etal., J. Pathol. 101:15-29 (1971)).

In another animal model of inflammatory pain, intradermal injection ofcapsaicin is used to neurogenic inflammation and hyperalgesia.Originally, response was observed and quantitated by visual inspectsionHowever, recent developments in thermography and laser-Doppler Flowmetryhave proved to be invaluable tools in quantitating neurogenicinflammation and inflammatory responses. For further details see, e.g.Sumikura et al., Pain 105(285-291 (2003).

(iv) Licking, Scratching and Biting Responses

Such responses can be induced, for example, by TNF-α (typically 100 pg),IFN-γ (typically 100 pg), or IL-1β (typically 100 pg) injectedintratracheally (i.t.), especially at higher dose (3 g/kg). In addition,similar responses can be elicited by i.t.injections of glutamate (20μg), N-methyl-D-aspartic acid (50 ng),α-amino-3-hydrocy-5-methylisoxazole-4-proprionic acid (13 ng) or kainicacid, or by administration for substance P or capsaicin.

(v) Neuropathic pain

Chronic constriction injury (CCI) of the sciatic nerve in rats inducespersistent mechanical hyperalgesia and allodyinia, and is a widely usedmodel of neuropathic pain (Bennett and Xie, Pain 33:87-107 (1988)).

(vi) Cancer pain

Candidate agents for the treatment of cancer pain can be tested in theabove-listed animals models of acute and chronic pain or inflammatorypain. In addition, there are several animal models available that havebeen specifically designed to test cancer pain.

For example, a candidate ErbB antagonist can be tested in a murine modelof bone cancer pain, as described in Menendez et al., Brain Res.969(102):102-9 (2003). This test investigated the reactivity to noxiousheat of C3G/HeJ mice receiving an intratibial (i.t.) injection of NCTC2472 cells. NCTC2472 cells are able to induce osteosarcoma, and breakthrough bone into soft tissues about two weeks after inoculation,producing a macroscopical increase of the limb size from the fourthweek. Thermal reactivity is diminished during the first two weeks aftercell implantation, and this hyperalgesia is reversed by theadministration of naloxone (10 mg/kg). According to the authors, duringthe fourth and fifth weeks after NCTC 2472 cell implantation, anincreased nociceptive heat reactivity, instead of hypoalgesia, wasobserved. This hyperalgesia was prevented by the systemic administrationof morphine (15 mg/kg). This animal model of bone cancer pain can beused to identify and study new agents, such as ErbB antagonists for themanagement of bone cancer pain, and potentially cancer pain in general.

Similarly, the effect of candidate ErbB antagonists on cancer pain canbe studied in tumor implanted mice, as described by Wacnik et al., Pain101(1-2):175-86 (2003).

A mouse model of neuropathic cancer pain has been developed by Shimoyamaet al., Pain 99(1-2):167-74 (2002). In this model, Meth A sarcoma cellswere inoculated to the immediate proximity of the scietic nerve inBALB/c mice. The growing tumor gradually compresses the nerve, therebycausing nerve injury. Time courses of thermal hyperalgesia andmechanical sensitivity to von Frey hairs are determined and signs ofspontaneous pain are evaluated.

An example of using mutant mice for pain threshold research is describedby Guilherme et al., Nature Neurosci. 6:221-222 (2003).

For a general overview of common animal models for pain see, e.g. Eaton,M., J. of Rehabilitation Research and Development 40(4) Suppl. 1:41-54(2003).

Human Clinical Trials

Pain measurement is essential for assessing analgesia. In human clinicaltrials, the pain experienced by an individual patient is assessed byusing one or more of the known measures of pain, including a VisualAnalog Scale (VAS), descriptive scale, numeric scale, Health AssessmentQuestionare (HAQ) pain index, and the like. A workshop sponsored by theInitiative on Methods, Measurement, and Pain Assessment in ClinicalTrials (IIVIMPACT) described six consensus domains recommended to beincluded in all chronic pain trials (Turk et al., Pain, 106(3):337-45(2003)).

Most frequently, pain is assessed using a VAS recorded on variousscales, such as a scale of 0 to 100, or 0 to 10, where the lowest scorerepresents no pain, and the highest score represents the worst possiblepain. Since it has been reported that patients have difficultydiscriminating 100 levels of pain, the most frequently used VAS systemoperates on a scale of 0 to 10 (Miller, GA, Psychological Review63:81-97 (1956).

The descriptive scale typically includes the following descriptions: nopain, mild pain, moderate pain, severe pain, very severe pain, and worstpossible pain.

In a preferred embodiment, the ErbB antagonists of the present inventionare anti-ErbB2 antibodies.

Production of anti-ErbB2 Antibodies

A description follows as to exemplary techniques for the production ofthe antibodies used in accordance with the present invention. The ErbB2antigen to be used for production of antibodies may be, e.g., a solubleform of the extracellular domain of ErbB2 or a portion thereof,containing the desired epitope. Alternatively, cells expressing ErbB2 attheir cell surface (e.g. NIH-3T3 cells transformed to overexpress ErbB2;or a carcinoma cell line such as SK-BR-3 cells, see Stancovski et al.PNAS (USA) 88:8691-8695 (199.1)) can be used to generate antibodies.Other forms of ErbB2 useful for generating antibodies will be apparentto those skilled in the art.

(i) Polyclonal Antibodies

Polyclonal antibodies are preferably raised in animals by multiplesubcutaneous (sc) or intraperitoneal (ip) injections of the relevantantigen and an adjuvant. It may be useful to conjugate the relevantantigen to a protein that is immunogenic in the species to be immunized,e.g., keyhole limpet hemocyanin, serum albumin, bovine thyroglobulin, orsoybean trypsin inhibitor using a bifunctional or derivatizing agent,for example, maleimidobenzoyl sulfosuccinimide ester (conjugationthrough cysteine residues), N-hydroxysuccinimide (through lysineresidues), glutaraldehyde, succinic anhydride, SOCl₂, or R¹N═C═NR, whereR and R¹ are different alkyl groups.

Animals are immunized against the antigen, immunogenic conjugates, orderivatives by combining, e.g., 100 μg or 5 μg of the protein orconjugate (for rabbits or mice, respectively) with 3 volumes of Freund'scomplete adjuvant and injecting the solution intradermally at multiplesites. One month later the animals are boosted with ⅕ to 1/10 theoriginal amount of peptide or conjugate in Freund's complete adjuvant bysubcutaneous injection at multiple sites. Seven to 14 days later theanimals are bled and the serum is assayed for antibody titer. Animalsare boosted until the titer plateaus. Preferably, the animal is boostedwith the conjugate of the same antigen, but conjugated to a differentprotein and/or through a different cross-linking reagent. Conjugatesalso can be made in recombinant cell culture as protein fusions. Also,aggregating agents such as alum are suitably used to enhance the immuneresponse.

(ii) Monoclonal Antibodies

Monoclonal antibodies are obtained from a population of substantiallyhomogeneous antibodies, i.e., the individual antibodies comprising thepopulation are identical except for variants that may arise during theproduction of the antibody. Thus, the modifier “monoclonal” indicatesthe character of the antibody as not being a mixture of discreteantibodies.

For example, the monoclonal antibodies may be made using the hybridomamethod first described by Kohler et al., Nature, 256:495 (1975), or maybe made by recombinant DNA methods (U.S. Pat. No. 4,816,567).

In the hybridoma method, a mouse or other appropriate host animal, suchas a hamster, is immunized as hereinabove described to elicitlymphocytes that produce or are capable of producing antibodies thatwill specifically bind to the protein used for immunization.Alternatively, lymphocytes may be immunized in vitro. Lymphocytes thenare fused with myeloma cells using a suitable fusing agent, such aspolyethylene glycol, to form a hybridoma cell (Goding, MonoclonalAntibodies: Principles and Practice, pp. 59-103 (Academic Press, 1986)).

The hybridoma cells thus prepared are seeded and grown in a suitableculture medium that preferably contains one or more substances thatinhibit the growth or survival of the unfused, parental myeloma cells.For example, if the parental myeloma cells lack the enzyme hypoxanthineguanine phosphoribosyl transferase (HGPRT or HPRT), the culture mediumfor the hybridomas typically will include hypoxanthine, aminopterin, andthymidine (HAT medium), which substances prevent the growth ofHGPRT-deficient cells.

Preferred myeloma cells are those that fuse efficiently, support stablehigh-level production of antibody by the selected antibody-producingcells, and are sensitive to a medium such as HAT medium. Among these,preferred myeloma cell lines are murine myeloma lines, such as thosederived from MOPC-21 and MPC-11 mouse tumors available from the SalkInstitute Cell Distribution Center, San Diego, Calif. USA, and SP-2 orX63-Ag8-653 cells available from the American Type Culture Collection,Rockville, Md. USA. Human myeloma and mouse-human heteromyeloma celllines also have been described for the production of human monoclonalantibodies (Kozbor, J. Immunol., 133:3001 (1984); and Brodeur et al.,Monoclonal Antibody Production Techniques and Applications, pp. 51-63(Marcel Dekker, Inc., New York, 1987)).

Culture medium in which hybridoma cells are growing is assayed forproduction of monoclonal antibodies directed against the antigen.Preferably, the binding specificity of monoclonal antibodies produced byhybridoma cells is determined by immunoprecipitation or by an in vitrobinding assay, such as radioimmunoassay (RIA) or enzyme-linkedimmunoabsorbent assay (ELISA).

The binding affinity of the monoclonal antibody can, for example, bedetermined by the Scatchard analysis of Munson et al., Anal. Biochem.,107:220 (1980).

After hybridoma cells are identified that produce antibodies of thedesired specificity, affinity, and/or activity, the clones may besubcloned by limiting dilution procedures and grown by standard methods(Goding, Monoclonal Antibodies: Principles and Practice, pp. 59-103(Academic Press, 1986)). Suitable culture media for this purposeinclude, for example, D-MEM or RPMI-1640 medium. In addition, thehybridoma cells may be grown in vivo as ascites tumors in an animal.

The monoclonal antibodies secreted by the subclones are suitablyseparated from the culture medium, ascites fluid, or serum byconventional antibody purification procedures such as, for example,protein A-Sepharose, hydroxylapatite chromatography, gelelectrophoresis, dialysis, or affinity chromatography.

DNA encoding the monoclonal antibodies is readily isolated and sequencedusing conventional procedures (e.g., by using oligonucleotide probesthat are capable of binding specifically to genes encoding the heavy andlight chains of murine antibodies). The hybridoma cells serve as apreferred source of such DNA. Once isolated, the DNA may be placed intoexpression vectors, which are then transfected into host cells such asE. coli cells, simian COS cells, Chinese Hamster Ovary (CHO) cells, ormyeloma cells that do not otherwise produce antibody protein, to obtainthe synthesis of monoclonal antibodies in the recombinant host cells.Review articles on recombinant expression in bacteria of DNA encodingthe antibody include Skerra et al., Curr. Opinion in Immunol., 5:256-262(1993) and Plückthun, Immunol. Revs., 130:151-188 (1992).

In a further embodiment, monoclonal antibodies or antibody fragments canbe isolated from antibody phage libraries generated using the techniquesdescribed in McCafferty et al., Nature, 348:552-554 (1990). Clackson etal., Nature, 352:624-628 (1991) and Marks et al., J. Mol. Biol.,222:581-597 (1991) describe the isolation of murine and humanantibodies, respectively, using phage libraries. Subsequent publicationsdescribe the production of high affinity (nM range) human antibodies bychain shuffling (Marks et al., Bio/Technology, 10:779-783 (1992)), aswell as combinatorial infection and in vivo recombination as a strategyfor constructing very large phage libraries (Waterhouse et al., Nuc.Acids. Res., 21:2265-2266 (1993)). Thus, these techniques are viablealternatives to traditional monoclonal antibody hybridoma techniques forisolation of monoclonal antibodies.

The DNA also may be modified, for example, by substituting the codingsequence for human heavy chain and light chain constant domains in placeof the homologous murine sequences (U.S. Pat. No. 4,816,567; andMorrison, et al., Proc. Natl. Acad. Sci. USA, 81:6851 (1984)), or bycovalently joining to the immunoglobulin coding sequence all or part ofthe coding sequence for a non-immunoglobulin polypeptide.

Typically such non-immunoglobulin polypeptides are substituted for theconstant domains of an antibody, or they are substituted for thevariable domains of one antigen-combining site of an antibody to createa chimeric bivalent antibody comprising one antigen-combining sitehaving specificity for an antigen and another antigen-combining sitehaving specificity for a different antigen.

(iii) Humanized Antibodies

Methods for humanizing non-human antibodies have been described in theart. Preferably, a humanized antibody has one or more amino acidresidues introduced into it from a source which is non-human. Thesenon-human amino acid residues are often referred to as “import”residues, which are typically taken from an “import” variable domain.Humanization can be essentially performed following the method of Winterand co-workers (Jones et al., Nature, 321:522-525 (1986); Riechmann etal., Nature, 332:323-327 (1988); Verhoeyen et al., Science,239:1534-1536 (1988)), by substituting hypervariable region sequencesfor the corresponding sequences of a human antibody. Accordingly, such“humanized” antibodies are chimeric antibodies (U.S. Pat. No. 4,816,567)wherein substantially less than an intact human variable domain has beensubstituted by the corresponding sequence from a non-human species. Inpractice, humanized antibodies are typically human antibodies in whichsome hypervariable region residues and possibly some FR residues aresubstituted by residues from analogous sites in rodent antibodies.

The choice of human variable domains, both light and heavy, to be usedin making the humanized antibodies is very important to reduceantigenicity. According to the so-called “best-fit” method, the sequenceof the variable domain of a rodent antibody is screened against theentire library of known human variable-domain sequences. The humansequence which is closest to that of the rodent is then accepted as thehuman framework region (FR) for the humanized antibody (Sims et al., J.Immunol., 151:2296 (1993); Chothia et al., J. Mol. Biol., 196:901(1987)). Another method uses a particular framework region derived fromthe consensus sequence of all human antibodies of a particular subgroupof light or heavy chains. The same framework may be used for severaldifferent humanized antibodies (Carter et al., Proc. Natl. Acad. Sci.USA, 89:4285 (1992); Presta et al., J. Immunol., 151:2623 (1993)).

It is further important that antibodies be humanized with retention ofhigh affinity for the antigen and other favorable biological properties.To achieve this goal, according to a preferred method, humanizedantibodies are prepared by a process of analysis of the parentalsequences and various conceptual humanized products usingthree-dimensional models of the parental and humanized sequences.Three-dimensional immunoglobulin models are commonly available and arefamiliar to those skilled in the art. Computer programs are availablewhich illustrate and display probable three-dimensional conformationalstructures of selected candidate immunoglobulin sequences. Inspection ofthese displays permits analysis of the likely role of the residues inthe functioning of the candidate immunoglobulin sequence, i.e., theanalysis of residues that influence the ability of the candidateimmunoglobulin to bind its antigen. In this way, FR residues can beselected and combined from the recipient and import sequences so thatthe desired antibody characteristic, such as increased affinity for thetarget antigen(s), is achieved. In general, the hypervariable regionresidues are directly and most substantially involved in influencingantigen binding.

Example 3 below describes production of exemplary humanized anti-ErbB2antibodies which bind ErbB2 and block ligand activation of an ErbB. Thehumanized antibody of particular interest herein blocks EGF, TGF-αand/or HRG mediated activation of MAPK essentially as effectively asmurine monoclonal antibody 2C4 (or a Fab fragment thereof) and/or bindsErbB2 essentially as effectively as murine monoclonal antibody 2C4 (or aFab fragment thereof). The humanized antibody herein may, for example,comprise nonhuman hypervariable region residues incorporated into ahuman variable heavy domain and may further comprise a framework region(FR) substitution at a position selected from the group consisting of69H, 71H and 73H utilizing the variable domain numbering system setforth in Kabat et al., Sequences of Proteins of Immunological Interest,5th Ed. Public Health Service, National Institutes of Health, Bethesda,Md. (1991). In one embodiment, the humanized antibody comprises FRsubstitutions at two or all of positions 69H, 71H and 73H.

An exemplary humanized antibody of interest herein comprises variableheavy domain complementarity determining residues GFTFTDYTMX, where X ispreferrably D or S (SEQ ID NO:7); DVNPNSGGSIYNQRFKG (SEQ ID NO:8);and/or NLGPSFYFDY (SEQ ID NO:9), optionally comprising amino acidmodifications of those CDR residues, e.g. where the modificationsessentially maintain or improve affinity of the antibody. For example,the antibody variant of interest may have from about one to about sevenor about five amino acid substitutions in the above variable heavy CDRsequences. Such antibody variants may be prepared by affinitymaturation, e.g., as described below. The most preferred humanizedantibody comprises the variable heavy domain amino acid sequence in SEQID NO:4.

The humanized antibody may comprise variable light domaincomplementarity determining residues KASQDVSIGVA (SEQ ID NO:10);SASYX¹X²X³, where X¹ is preferably R or L, X² is preferably Y or E, andX³ is preferably T or S (SEQ ID NO:11); and/or QQYYIYPYT (SEQ ID NO:12),e.g. in addition to those variable heavy domain CDR residues in thepreceding paragraph. Such humanized antibodies optionally comprise aminoacid modifications of the above CDR residues, e.g. where themodifications essentially maintain or improve affinity of the antibody.For example, the antibody variant of interest may have from about one toabout seven or about five amino acid substitutions in the above variablelight CDR sequences. Such antibody variants may be prepared by affinitymaturation, e.g., as described below. The most preferred humanizedantibody comprises the variable light domain amino acid sequence in SEQID NO:3.

The present application also contemplates affinity matured antibodieswhich bind ErbB2 and block ligand activation of an ErbB. The parentantibody may be a human antibody or a humanized antibody, e.g., onecomprising the variable light and/or heavy sequences of SEQ ID Nos. 3and 4, respectively (i.e. variant 574). The affinity matured antibodypreferably binds to ErbB2 receptor with an affinity superior to that ofmurine 2C4 or variant 574 (e.g. from about two or about four fold, toabout 100 fold or about 1000 fold improved affinity, e.g. as assessedusing a ErbB2-extracellular domain (ECD) ELISA). Exemplary variableheavy CDR residues for substitution include H28, H30, H34, 1135, H64,H96, H99, or combinations of two or more (e.g. two, three, four, five,six, or seven of these residues). Examples of variable light CDRresidues for alteration include L28, L50, L53, L56, L91, L92, L93, L94,L96, L97 or combinations of two or more (e.g. two to three, four, fiveor up to about ten of these residues).

Various forms of the humanized antibody or affinity matured antibody arecontemplated. For example, the humanized antibody or affinity maturedantibody may be an antibody fragment, such as a Fab, which is optionallyconjugated with one or more cytotoxic agent(s) in order to generate animmunoconjugate. Alternatively, the humanized antibody or affinitymatured antibody may be an intact antibody, such as an intact IgG1antibody.

(iv) Human Antibodies

As an alternative to humanization, human antibodies can be generated.For example, it is now possible to produce transgenic animals (e.g.,mice) that are capable, upon immunization, of producing a fullrepertoire of human antibodies in the absence of endogenousimmunoglobulin production. For example, it has been described that thehomozygous deletion of the antibody heavy-chain joining region (J_(H))gene in chimeric and germ-line mutant mice results in completeinhibition of endogenous antibody production. Transfer of the humangerm-line immunoglobulin gene array in such germ-line mutant mice willresult in the production of human antibodies upon antigen challenge.See, e.g., Jakobovits et al., Proc. Natl. Acad. Sci. USA, 90:2551(1993); Jakobovits et al., Nature, 362:255-258 (1993); Bruggemann etal., Year in Immuno., 7:33 (1993); and U.S. Pat. Nos. 5,591,669,5,589,369 and 5,545,807.

Alternatively, phage display technology (McCafferty et al., Nature348:552-553 (1990)) can be used to produce human antibodies and antibodyfragments in vitro, from immunoglobulin variable (V) domain generepertoires from unimmunized donors. According to this technique,antibody V domain genes are cloned in-frame into either a major or minorcoat protein gene of a filamentous bacteriophage, such as M13 or fd, anddisplayed as functional antibody fragments on the surface of the phageparticle. Because the filamentous particle contains a single-strandedDNA copy of the phage genome, selections based on the functionalproperties of the antibody also result in selection of the gene encodingthe antibody exhibiting those properties. Thus, the phage mimics some ofthe properties of the B-cell. Phage display can be performed in avariety of formats; for their review see, e.g., Johnson, Kevin S, andChiswell, David J., Current Opinion in Structural Biology 3:564-571(1993). Several sources of V-gene segments can be used for phagedisplay. Clackson et al., Nature, 352:624-628 (1991) isolated a diversearray of anti-oxazolone antibodies from a small random combinatoriallibrary of V genes derived from the spleens of immunized mice. Arepertoire of V genes from unimmunized human donors can be constructedand antibodies to a diverse array of antigens (including self-antigens)can be isolated essentially following the techniques described by Markset al., J. Mol. Biol. 222:581-597 (1991), or Griffith et al., EMBO J.12:725-734 (1993). See, also, U.S. Pat. Nos. 5,565,332 and 5,573,905.

As discussed above, human antibodies may also be generated by in vitroactivated B cells (see U.S. Pat. Nos. 5,567,610 and 5,229,275).

Human anti-ErbB2 antibodies are described in U.S. Pat. No. 5,772,997issued Jun. 30, 1998; WO 97/00271 published Jan. 3, 1997; and WO01/09187published Feb. 8, 2001 (Medarex).

(v) Antibody Fragments

Various techniques have been developed for the production of antibodyfragments. Traditionally, these fragments were derived via proteolyticdigestion of intact antibodies (see, e.g., Morimoto et al., Journal ofBiochemical and Biophysical Methods 24:107-117 (1992); and Brennan etal., Science, 229:81 (1985)). However, these fragments can now beproduced directly by recombinant host cells. For example, the antibodyfragments can be isolated from the antibody phage libraries discussedabove. Alternatively, Fab′-SH fragments can be directly recovered fromE. coli and chemically coupled to form F(ab′)₂ fragments (Carter et al.,Bio/Technology 10:163-167 (1992)). According to another approach,F(ab′)₂ fragments can be isolated directly from recombinant host cellculture. Other techniques for the production of antibody fragments willbe apparent to the skilled practitioner. In other embodiments, theantibody of choice is a single chain Fv fragment (scFv). See WO93/16185; U.S. Pat. No. 5,571,894; and U.S. Pat. No. 5,587,458. Theantibody fragment may also be a “linear antibody”, e.g., as described inU.S. Pat. No. 5,641,870 for example. Such linear antibody fragments maybe monospecific or bispecific. Single chain intracellular antibodies(sFv) that bind ErbB2 are described in WO01/56604 and U.S. Pat. No.6,028,059.

(vi) Bispecific Antibodies

Bispecific antibodies are antibodies that have binding specificities forat least two different epitopes. Exemplary bispecific antibodies maybind to two different epitopes of the ErbB2 protein. Other suchantibodies may combine an ErbB2 binding site with binding site(s) forEGFR, ErbB3 and/or ErbB4. Alternatively, an anti-ErbB2 arm may becombined with an arm which binds to a triggering molecule on a leukocytesuch as a T-cell receptor molecule (e.g. CD2 or CD3), or Fc receptorsfor IgG (FcγR), such as FcγRI (CD64), FcγRII (CD32) and FcγRIII (CD16)so as to focus cellular defense mechanisms to the ErbB2-expressing cell.Bispecific antibodies may also be used to localize cytotoxic agents tocells which express ErbB2. These antibodies possess an ErbB2-binding armand an arm which binds the cytotoxic agent (e.g. saporin,anti-interferon-α, vinca alkaloid, ricin A chain, methotrexate orradioactive isotope hapten). Bispecific antibodies can be prepared asfull length antibodies or antibody fragments (e.g. F(ab′)₂ bispecificantibodies).

WO 96/16673 describes a bispecific anti-ErbB2/anti-FcγRIII antibody andU.S. Pat. No. 5,837,234 discloses a bispecific anti-ErbB2/anti-FcγRIantibody. A bispecific anti-ErbB2/Fcα antibody is shown in WO98/02463.U.S. Pat. No. 5,821,337 teaches a bispecific anti-ErbB2/anti-CD3antibody.

Methods for making bispecific antibodies are known in the art.Traditional production of full length bispecific antibodies is based onthe coexpression of two immunoglobulin heavy chain-light chain pairs,where the two chains have different specificities (Milstein et al.,Nature, 305:537-539 (1983)). Because of the random assortment ofimmunoglobulin heavy and light chains, these hybridomas (quadromas)produce a potential mixture of 10 different antibody molecules, of whichonly one has the correct bispecific structure. Purification of thecorrect molecule, which is usually done by affinity chromatographysteps, is rather cumbersome, and the product yields are low. Similarprocedures are disclosed in WO 93/08829, and in Traunecker et al., EMBOJ., 10:3655-3659 (1991).

According to a different approach, antibody variable domains with thedesired binding specificities (antibody-antigen combining sites) arefused to immunoglobulin constant domain sequences. The fusion preferablyis with an immunoglobulin heavy chain constant domain, comprising atleast part of the hinge, CH2, and CH3 regions. It is preferred to havethe first heavy-chain constant region (CH1) containing the sitenecessary for light chain binding, present in at least one of thefusions. DNAs encoding the immunoglobulin heavy chain fusions and, ifdesired, the immunoglobulin light chain, are inserted into separateexpression vectors, and are co-transfected into a suitable hostorganism. This provides for great flexibility in adjusting the mutualproportions of the three polypeptide fragments in embodiments whenunequal ratios of the three polypeptide chains used in the constructionprovide the optimum yields. It is, however, possible to insert thecoding sequences for two or all three polypeptide chains in oneexpression vector when the expression of at least two polypeptide chainsin equal ratios results in high yields or when the ratios are of noparticular significance.

In a preferred embodiment of this approach, the bispecific antibodiesare composed of a hybrid immunoglobulin heavy chain with a first bindingspecificity in one arm, and a hybrid immunoglobulin heavy chain-lightchain pair (providing a second binding specificity) in the other arm. Itwas found that this asymmetric structure facilitates the separation ofthe desired bispecific compound from unwanted immunoglobulin chaincombinations, as the presence of an immunoglobulin light chain in onlyone half of the bispecific molecule provides for a facile way ofseparation. This approach is disclosed in WO 94/04690. For furtherdetails of generating bispecific antibodies see, for example, Suresh etal., Methods in Enzymology, 121:210 (1986).

According to another approach described in U.S. Pat. No. 5,731,168, theinterface between a pair of antibody molecules can be engineered tomaximize the percentage of heterodimers which are recovered fromrecombinant cell culture. The preferred interface comprises at least apart of the C_(H)3 domain of an antibody constant domain. In thismethod, one or more small amino acid side chains from the interface ofthe first antibody molecule are replaced with larger side chains (e.g.tyrosine or tryptophan). Compensatory “cavities” of identical or similarsize to the large side chain(s) are created on the interface of thesecond antibody molecule by replacing large amino acid side chains withsmaller ones (e.g. alanine or threonine). This provides a mechanism forincreasing the yield of the heterodimer over other unwanted end-productssuch as homodimers.

Bispecific antibodies include cross-linked or “heteroconjugate”antibodies. For example, one of the antibodies in the heteroconjugatecan be coupled to avidin, the other to biotin. Such antibodies have, forexample, been proposed to target immune system cells to unwanted cells(U.S. Pat. No. 4,676,980), and for treatment of HIV infection (WO91/00360, WO 92/200373, and EP 03089). Heteroconjugate antibodies may bemade using any convenient cross-linking methods. Suitable cross-linkingagents are well known in the art, and are disclosed in U.S. Pat. No.4,676,980, along with a number of cross-linking techniques.

Techniques for generating bispecific antibodies from antibody fragmentshave also been described in the literature. For example, bispecificantibodies can be prepared using chemical linkage. Brennan et al.,Science, 229: 81 (1985) describe a procedure wherein intact antibodiesare proteolytically cleaved to generate F(ab′)₂ fragments. Thesefragments are reduced in the presence of the dithiol complexing agentsodium arsenite to stabilize vicinal dithiols and prevent intermoleculardisulfide formation. The Fab′ fragments generated are then converted tothionitrobenzoate (TNB) derivatives. One of the Fab′-TNB derivatives isthen reconverted to the Fab′-thiol by reduction with mercaptoethylamineand is mixed with an equimolar amount of the other Fab′-TNB derivativeto form the bispecific antibody. The bispecific antibodies produced canbe used as agents for the selective immobilization of enzymes.

Recent progress has facilitated the direct recovery of Fab′-SH fragmentsfrom E. coli, which can be chemically coupled to form bispecificantibodies. Shalaby et al., J. Exp. Med., 175: 217-225 (1992) describethe production of a fully humanized bispecific antibody F(ab′)₂molecule. Each Fab′ fragment was separately secreted from E. coli andsubjected to directed chemical coupling in vitro to form the bispecificantibody. The bispecific antibody thus formed was able to bind to cellsoverexpressing the ErbB2 receptor and normal human T cells, as well astrigger the lytic activity of human cytotoxic lymphocytes against humanbreast tumor targets.

Various techniques for making and isolating bispecific antibodyfragments directly from recombinant cell culture have also beendescribed. For example, bispecific antibodies have been produced usingleucine zippers. Kostelny et al., J. Immunol., 148(5):1547-1553 (1992).The leucine zipper peptides from the Fos and Jun proteins were linked tothe Fab′ portions of two different antibodies by gene fusion. Theantibody homodimers were reduced at the hinge region to form monomersand then re-oxidized to form the antibody heterodimers. This method canalso be utilized for the production of antibody homodimers. The“diabody” technology described by Hollinger et al., Proc. Natl. Acad.Sci. USA, 90:6444-6448 (1993) has provided an alternative mechanism formaking bispecific antibody fragments. The fragments comprise aheavy-chain variable domain (V_(H)) connected to a light-chain variabledomain (V_(L)) by a linker which is too short to allow pairing betweenthe two domains on the same chain. Accordingly, the V_(H) and V_(L)domains of one fragment are forced to pair with the complementary V_(L)and V_(H) domains of another fragment, thereby forming twoantigen-binding sites. Another strategy for making bispecific antibodyfragments by the use of single-chain Fv (sFv) dimers has also beenreported. See Gruber et al., J. Immunol., 152:5368 (1994).

Antibodies with more than two valencies are contemplated. For example,trispecific antibodies can be prepared. Tutt et al. J. Immunol. 147: 60(1991). U.S. Pat. No. 6,270,765B1 published Aug. 7, 2001 describestrispecific antibodies that bind ErbB2, EGFR and FcR.

(vii) Other Amino Acid Sequence Modifications

Amino acid sequence modification(s) of the anti-ErbB2 antibodiesdescribed herein are contemplated. For example, it may be desirable toimprove the binding affinity and/or other biological properties of theantibody. Amino acid sequence variants of the anti-ErbB2 antibody areprepared by introducing appropriate nucleotide changes into theanti-ErbB2 antibody nucleic acid, or by peptide synthesis. Suchmodifications include, for example, deletions from, and/or insertionsinto and/or substitutions of, residues within the amino acid sequencesof the anti-ErbB2 antibody. Any combination of deletion, insertion, andsubstitution is made to arrive at the final construct, provided that thefinal construct possesses the desired characteristics. The amino acidchanges also may alter post-translational processes of the anti-ErbB2antibody, such as changing the number or position of glycosylationsites.

A useful method for identification of certain residues or regions of theanti-ErbB2 antibody that are preferred locations for mutagenesis iscalled “alanine scanning mutagenesis” as described by Cunningham andWells Science, 244:1081-1085 (1989). Here, a residue or group of targetresidues are identified (e.g., charged residues such as arg, asp, his,lys, and glu) and replaced by a neutral or negatively charged amino acid(most preferably alanine or polyalanine) to affect the interaction ofthe amino acids with ErbB2 antigen. Those amino acid locationsdemonstrating functional sensitivity to the substitutions then arerefined by introducing further or other variants at, or for, the sitesof substitution. Thus, while the site for introducing an amino acidsequence variation is predetermined, the nature of the mutation per seneed not be predetermined. For example, to analyze the performance of amutation at a given site, ala scanning or random mutagenesis isconducted at the target codon or region and the expressed anti-ErbB2antibody variants are screened for the desired activity.

Amino acid sequence insertions include amino- and/or carboxyl-terminalfusions ranging in length from one residue to polypeptides containing ahundred or more residues, as well as intrasequence insertions of singleor multiple amino acid residues. Examples of terminal insertions includean anti-ErbB2 antibody with an N-terminal methionyl residue or theantibody fused to a cytotoxic polypeptide. Other insertional variants ofthe anti-ErbB2 antibody molecule include the fusion to the—or C-terminusof the anti-ErbB2 antibody to an enzyme (e.g. for ADEPT) or apolypeptide which increases the serum half-life of the antibody.

Another type of variant is an amino acid substitution variant. Thesevariants have at least one amino acid residue in the anti-ErbB2 antibodymolecule replaced by a different residue. The sites of greatest interestfor substitutional mutagenesis include the hypervariable regions, but FRalterations are also contemplated. Conservative substitutions are shownin Table 1 under the heading of “preferred substitutions”. If suchsubstitutions result in a change in biological activity, then moresubstantial changes, denominated “exemplary substitutions” in Table 1,or as further described below in reference to amino acid classes, may beintroduced and the products screened.

TABLE 1 Original Exemplary Preferred Residue Substitutions SubstitutionsAla (A) val; leu; ile val Arg (R) lys; gln; asn lys Asn (N) gln; his;asp, lys; arg gln Asp (D) glu; asn glu Cys (C) ser; ala ser Gln (Q) asn;glu asn Glu (E) asp; gln asp Gly (G) Ala ala His (H) asn; gln; lys; argarg Ile (I) leu; val; met; ala; leu phe; norleucine Leu (L) norleucine;ile; val; ile met; ala; phe Lys (K) arg; gln; asn arg Met (M) leu; phe;ile leu Phe (F) leu; val; ile; ala; tyr tyr Pro (P) Ala ala Ser (S) Thrthr Thr (T) Ser ser Trp (W) tyr; phe tyr Tyr (Y) trp; phe; thr; ser pheVal (V) ile; leu; met; phe; leu ala; norleucine

Substantial modifications in the biological properties of the antibodyare accomplished by selecting substitutions that differ significantly intheir effect on maintaining (a) the structure of the polypeptidebackbone in the area of the substitution, for example, as a sheet orhelical conformation, (b) the charge or hydrophobicity of the moleculeat the target site, or (c) the bulk of the side chain. Naturallyoccurring residues are divided into groups based on common side-chainproperties:

-   -   (1) hydrophobic: norleucine, met, ala, val, leu, ile;    -   (2) neutral hydrophilic: cys, ser, thr;    -   (3) acidic: asp, glu;    -   (4) basic: asn, gln, his, lys, arg;    -   (5) residues that influence chain orientation: gly, pro; and    -   (6) aromatic: trp, tyr, phe.

Non-conservative substitutions will entail exchanging a member of one ofthese classes for another class.

Any cysteine residue not involved in maintaining the proper conformationof the anti-ErbB2 antibody also may be substituted, generally withserine, to improve the oxidative stability of the molecule and preventaberrant crosslinking. Conversely, cysteine bond(s) may be added to theantibody to improve its stability (particularly where the antibody is anantibody fragment such as an Fv fragment).

A particularly preferred type of substitutional variant involvessubstituting one or more hypervariable region residues of a parentantibody (e.g. a humanized or human antibody). Generally, the resultingvariant(s) selected for further development will have improvedbiological properties relative to the parent antibody from which theyare generated. A convenient way for generating such substitutionalvariants involves affinity maturation using phage display. Briefly,several hypervariable region sites (e.g. 6-7 sites) are mutated togenerate all possible amino substitutions at each site. The antibodyvariants thus generated are displayed in a monovalent fashion fromfilamentous phage particles as fusions to the gene III product of M13packaged within each particle. The phage-displayed variants are thenscreened for their biological activity (e.g. binding affinity) as hereindisclosed. In order to identify candidate hypervariable region sites formodification, alanine scanning mutagenesis can be performed to identifyhypervariable region residues contributing significantly to antigenbinding. Alternatively, or additionally, it may be beneficial to analyzea crystal structure of the antigen-antibody complex to identify contactpoints between the antibody and human ErbB2. Such contact residues andneighboring residues are candidates for substitution according to thetechniques elaborated herein. Once such variants are generated, thepanel of variants is subjected to screening as described herein andantibodies with superior properties in one or more relevant assays maybe selected for further development.

Another type of amino acid variant of the antibody alters the originalglycosylation pattern of the antibody. By altering is meant deleting oneor more carbohydrate moieties found in the antibody, and/or adding oneor more glycosylation sites that are not present in the antibody.

Glycosylation of antibodies is typically either N-linked or O-linked.N-linked refers to the attachment of the carbohydrate moiety to the sidechain of an asparagine residue. The tripeptide sequencesasparagine-X-serine and asparagine-X-threonine, where X is any aminoacid except proline, are the recognition sequences for enzymaticattachment of the carbohydrate moiety to the asparagine side chain.Thus, the presence of either of these tripeptide sequences in apolypeptide creates a potential glycosylation site. O-linkedglycosylation refers to the attachment of one of the sugarsN-aceylgalactosamine, galactose, or xylose to a hydroxyamino acid, mostcommonly serine or threonine, although 5-hydroxyproline or5-hydroxylysine may also be used.

Addition of glycosylation sites to the antibody is convenientlyaccomplished by altering the amino acid sequence such that it containsone or more of the above-described tripeptide sequences (for N-linkedglycosylation sites). The alteration may also be made by the additionof, or substitution by, one or more serine or threonine residues to thesequence of the original antibody (for O-linked glycosylation sites).

Nucleic acid molecules encoding amino acid sequence variants of theanti-ErbB2 antibody are prepared by a variety of methods known in theart. These methods include, but are not limited to, isolation from anatural source (in the case of naturally occurring amino acid sequencevariants) or preparation by oligonucleotide-mediated (or site-directed)mutagenesis, PCR mutagenesis, and cassette mutagenesis of an earlierprepared variant or a non-variant version of the anti-ErbB2 antibody.

It may be desirable to modify the antibody of the invention with respectto effector function, e.g. so as to enhance antigen-dependentcell-mediated cytotoxicity (ADCC) and/or complement dependentcytotoxicity (CDC) of the antibody. This may be achieved by introducingone or more amino acid substitutions in an Fc region of the antibody.Alternatively or additionally, cysteine residue(s) may be introduced inthe Fc region, thereby allowing interchain disulfide bond formation inthis region. The homodimeric antibody thus generated may have improvedinternalization capability and/or increased complement-mediated cellkilling and antibody-dependent cellular cytotoxicity (ADCC). See Caronet al., J. Exp Med. 176:1191-1195 (1992) and Shopes, B. J. Immunol.148:2918-2922 (1992). Homodimeric antibodies with enhanced activity mayalso be prepared using heterobifunctional cross-linkers as described inWolff et al. Cancer Research 53:2560-2565 (1993). Alternatively, anantibody can be engineered which has dual Fc regions and may therebyhave enhanced complement lysis and ADCC capabilities. See Stevenson etal. Anti-Cancer Drug Design 3:219-230 (1989).

Antibody variants with altered Fc region sequence and improved ordiminished C1q binding are described in WO99/51642. Antibody variantswith altered Fc region sequences and altered FcR binding function aredescribed in WO00/42072.

To increase the serum half life of the antibody, one may incorporate asalvage receptor binding epitope into the antibody (especially anantibody fragment) as described in U.S. Pat. No. 5,739,277, for example.As used herein, the term “salvage receptor binding epitope” refers to anepitope of the Fc region of an IgG molecule (e.g., IgG₁, IgG₂, IgG₃, orIgG₄) that is responsible for increasing the in vivo serum half-life ofthe IgG molecule.

(viii) Screening for Antibodies with the Desired Properties

Techniques for generating antibodies have been described above. One mayfurther select antibodies with certain biological characteristics, asdesired.

To identify an antibody which blocks ligand activation of an ErbB, theability of the antibody to block ErbB ligand binding to cells expressingthe ErbB (e.g. in conjugation with another ErbB with which the ErbB ofinterest forms an ErbB hetero-oligomer) may be determined. For example,cells naturally expressing, or transfected to express, ErbBs of the ErbBhetero-oligomer may be incubated with the antibody and then exposed tolabeled ErbB ligand. The ability of the anti-ErbB2 antibody to blockligand binding to the ErbB in the ErbB hetero-oligomer may then beevaluated.

For example, inhibition of HRG binding to MCF7 breast tumor cell linesby anti-ErbB2 antibodies may be performed using monolayer MCF7 cultureson ice in a 24-well-plate format essentially as described in Example 1below. Anti-ErbB2 monoclonal antibodies may be added to each well andincubated for 30 minutes. ¹²⁵I-labeled rHRGβ1₁₇₇₋₂₂₄ (25 pm) may then beadded, and the incubation may be continued for 4 to 16 hours. Doseresponse curves may be prepared and an IC₅₀ value may be calculated forthe antibody of interest. In one embodiment, the antibody which blocksligand activation of an ErbB will have an IC₅₀ for inhibiting HRGbinding to MCF7 cells in this assay of about 50 nM or less, morepreferably 10 nM or less. Where the antibody is an antibody fragmentsuch as a Fab fragment, the IC₅₀ for inhibiting HRG binding to MCF7cells in this assay may, for example, be about 100 nM or less, morepreferably 50 nM or less. Other, non-antibody, ErbB antagonistcandidates can be tested in a similar manner.

Alternatively, or additionally, the ability of the anti-ErbB2 antibodyto block ErbB ligand-stimulated tyrosine phosphorylation of an ErbBpresent in an ErbB hetero-oligomer may be assessed. For example, cellsendogenously expressing the ErbBs or transfected to expressed them maybe incubated with the antibody and then assayed for ErbBligand-dependent tyrosine phosphorylation activity using ananti-phosphotyrosine monoclonal (which is optionally conjugated with adetectable label). The kinase receptor activation assay described inU.S. Pat. No. 5,766,863 is also available for determining ErbBactivation and blocking of that activity by an antibody.

In one embodiment, one may screen for an antibody which inhibits HRGstimulation of p180 tyrosine phosphorylation in MCF7 cells essentiallyas described in Example 1 below. For example, the MCF7 cells may beplated in 24-well plates and monoclonal antibodies to ErbB2 may be addedto each well and incubated for 30 minutes at room temperature; thenrHRGβ1₁₇₇₋₂₄₄ may be added to each well to a final concentration of 0.2nM, and the incubation may be continued for 8 minutes. Media may beaspirated from each well, and reactions may be stopped by the additionof 100 μl of SDS sample buffer (5% SDS, 25 mM DTT, and 25 mM Tris-HCl,pH 6.8). Each sample (25 μl) may be electrophoresed on a 4-12% gradientgel (Novex) and then electrophoretically transferred to polyvinylidenedifluoride membrane. Antiphosphotyrosine (at 1 μg/ml) immunoblots may bedeveloped, and the intensity of the predominant reactive band atM_(r)˜180,000 may be quantified by reflectance densitometry. Theantibody selected will preferably significantly inhibit HRG stimulationof p180 tyrosine phosphorylation to about 0-35% of control in thisassay. A dose-response curve for inhibition of HRG stimulation of p180tyrosine phosphorylation as determined by reflectance densitometry maybe prepared and an IC₅₀ for the antibody of interest may be calculated.In one embodiment, the antibody which blocks ligand activation of anErbB will have an IC₅₀ for inhibiting HRG stimulation of p180 tyrosinephosphorylation in this assay of about 50 nM or less, more preferably 10nM or less. Where the antibody is an antibody fragment such as a Fabfragment, the IC₅₀ for inhibiting HRG stimulation of p180 tyrosinephosphorylation in this assay may, for example, be about 100 nM or less,more preferably 50 nM or less.

One may also assess the growth inhibitory effects of the antibody onMDA-MB-175 cells, e.g, essentially as described in Schaefer et al.Oncogene 15:1385-1394 (1997). According to this assay, MDA-MB-175 cellsmay treated with an anti-ErbB2 monoclonal antibody (10 μg/mL) for 4 daysand stained with crystal violet. Incubation with an anti-ErbB2 antibodymay show a growth inhibitory effect on this cell line similar to thatdisplayed by monoclonal antibody 2C4. In a further embodiment, exogenousHRG will not significantly reverse this inhibition. Preferably, theantibody will be able to inhibit cell proliferation of MDA-MB-175 cellsto a greater extent than monoclonal antibody 4D5 (and optionally to agreater extent than monoclonal antibody 7F3), both in the presence andabsence of exogenous HRG.

In one embodiment, the anti-ErbB2 antibody of interest may blockheregulin dependent association of ErbB2 with ErbB3 in both MCF7 andSK-BR-3 cells as determined in a co-immunoprecipitation experiment suchas that described in Example 2 substantially more effectively thanmonoclonal antibody 4D5, and preferably substantially more effectivelythan monoclonal antibody 7F3.

To identify growth inhibitory anti-ErbB2 antibodies, one may screen forantibodies which inhibit the growth of cancer cells which overexpressErbB2. In one embodiment, the growth inhibitory antibody of choice isable to inhibit growth of SK-BR-3 cells in cell culture by about 20-100%and preferably by about 50-100% at an antibody concentration of about0.5 to 30 μg/ml. To identify such antibodies, the SK-BR-3 assaydescribed in U.S. Pat. No. 5,677,171 can be performed. According to thisassay, SK-BR-3 cells are grown in a 1:1 mixture of F12 and DMEM mediumsupplemented with 10% fetal bovine serum, glutamine and penicillinstreptomycin. The SK-BR-3 cells are plated at 20,000 cells in a 35 mmcell culture dish (2 m-1s/35 mm dish). 0.5 to 30 μg/ml of the anti-ErbB2antibody is added per dish. After six days, the number of cells,compared to untreated cells are counted using an electronic COULTER□cell counter. Those antibodies which inhibit growth of the SK-BR-3 cellsby about 20-100% or about 50-100% may be selected as growth inhibitoryantibodies.

To select for antibodies which induce cell death, loss of membraneintegrity as indicated by, e.g., PI, trypan blue or 7AAD uptake may beassessed relative to control. The preferred assay is the PI uptake assayusing BT474 cells. According to this assay, BT474 cells (which can beobtained from the American Type Culture Collection (Rockville, Md.)) arecultured in Dulbecco's Modified Eagle Medium (D-MEM):Ham's F-12 (50:50)supplemented with 10% heat-inactivated FBS (Hyclone) and 2 mML-glutamine. (Thus, the assay is performed in the absence of complementand immune effector cells). The BT474 cells are seeded at a density of3×10⁶ per dish in 100×20 mm dishes and allowed to attach overnight. Themedium is then removed and replaced with fresh medium alone or mediumcontaining 10 μg/ml of the appropriate monoclonal antibody. The cellsare incubated for a 3 day time period. Following each treatment,monolayers are washed with PBS and detached by trypsinization. Cells arethen centrifuged at 1200 rpm for 5 minutes at 4° C., the pelletresuspended in 3 ml ice cold Ca²⁺ binding buffer (10 mM Hepes, pH 7.4,140 mM NaCl, 2.5 mM CaCl₂) and aliquoted into 35 mm strainer-capped12×75 tubes (1 ml per tube, 3 tubes per treatment group) for removal ofcell clumps. Tubes then receive PI (10 μg/ml). Samples may be analyzedusing a FACSCAN® flow cytometer and FACSCONVERT® CellQuest software(Becton Dickinson). Those antibodies which induce statisticallysignificant levels of cell death as determined by PI uptake may beselected as cell death-inducing antibodies.

In order to select for antibodies which induce apoptosis, an annexinbinding assay using BT474 cells is available. The BT474 cells arecultured and seeded in dishes as discussed in the preceding paragraph.The medium is then removed and replaced with fresh medium alone ormedium containing 10 μg/ml of the monoclonal antibody. Following a threeday incubation period, monolayers are washed with PBS and detached bytrypsinization. Cells are then centrifuged, resuspended in Ca²⁺ bindingbuffer and aliquoted into tubes as discussed above for the cell deathassay. Tubes then receive labeled annexin (e.g. annexin V-FTIC) (1μg/ml). Samples may be analyzed using a FACSCAN® flow cytometer andFACSCONVERT® CellQuest software (Becton Dickinson). Those antibodieswhich induce statistically significant levels of annexin bindingrelative to control are selected as apoptosis-inducing antibodies.

In addition to the annexin binding assay, a DNA staining assay usingBT474 cells is available. In order to perform this assay, BT474 cellswhich have been treated with the antibody of interest as described inthe preceding two paragraphs are incubated with 9 μg/ml HOECHST 33342®for 2 hr at 37° C., then analyzed on an EPICS ELITE® flow cytometer(Coulter Corporation) using MODFIT LT® software (Verity Software House).Antibodies which induce a change in the percentage of apoptotic cellswhich is 2 fold or greater (and preferably 3 fold or greater) thanuntreated cells (up to 100% apoptotic cells) may be selected aspro-apoptotic antibodies using this assay.

To screen for antibodies which bind to an epitope on ErbB2 bound by anantibody of interest, a routine cross-blocking assay such as thatdescribed in Antibodies, A Laboratory Manual, Cold Spring HarborLaboratory, Ed Harlow and David Lane (1988), can be performed.Alternatively, or additionally, epitope mapping can be performed bymethods known in the art (see, e.g. FIGS. 1A and 1B herein).

The antibodies identified as antagonists can then be tested in any ofthe animal models of pain discussed above.

(ix) Immunoconjugates

The ErbB antagonist antibodies of the invention can also be in the formof immunoconjugates comprising an antibody conjugated to a cytotoxicagent such as a chemotherapeutic agent, toxin (e.g. a small moleculetoxin or an enzymatically active toxin of bacterial, fungal, plant oranimal origin, including fragments and/or variants thereof), or aradioactive isotope (i.e., a radioconjugate).

Chemotherapeutic agents useful in the generation of suchimmunoconjugates have been described above. Conjugates of an antibodyand one or more small molecule toxins, such as a calicheamicin, amaytansine (U.S. Pat. No. 5,208,020), a trichothene, and CC1065 are alsocontemplated herein.

In one preferred embodiment of the invention, the antibody is conjugatedto one or more maytansine molecules (e.g. about 1 to about 10 maytansinemolecules per antibody molecule). Maytansine may, for example, beconverted to May-SS-Me which may be reduced to May-SH3 and reacted withmodified antibody (Chari et al. Cancer Research 52: 127-131 (1992)) togenerate a maytansinoid-antibody immunoconjugate.

Another immunoconjugate of interest comprises an anti-ErbB2 antibodyconjugated to one or more calicheamicin molecules. The calicheamicinfamily of antibiotics are capable of producing double-stranded DNAbreaks at sub-picomolar concentrations. Structural analogues ofcalicheamicin which may be used include, but are not limited to, γ₁^(I), α₂ ^(I), α₂ ^(I), N-acetyl-γ₁ ^(I), PSAG and θ^(I) ₁, (Hinman etal. Cancer Research 53: 3336-3342 (1993) and Lode et al. Cancer Research58: 2925-2928 (1998)). See, also, U.S. Pat. Nos. 5,714,586; 5,712,374;5,264,586; and 5,773,001 expressly incorporated herein by reference.

Enzymatically active toxins and fragments thereof which can be usedinclude diphtheria A chain, nonbinding active fragments of diphtheriatoxin, exotoxin A chain (from Pseudomonas aeruginosa), ricin A chain,abrin A chain, modeccin A chain, alpha-sarcin, Aleurites fordiiproteins, dianthin proteins, Phytolaca americana proteins (PAPI, PAPII,and PAP-S), momordica charantia inhibitor, curcin, crotin, sapaonariaofficinalis inhibitor, gelonin, mitogellin, restrictocin, phenomycin,enomycin and the tricothecenes. See, for example, WO 93/21232 publishedOct. 28, 1993.

The present invention further contemplates an immunoconjugate formedbetween an antibody and a compound with nucleolytic activity (e.g. aribonuclease or a DNA endonuclease such as a deoxyribonuclease; DNase).

A variety of radioactive isotopes are available for the production ofradioconjugated anti-ErbB2 antibodies. Examples include At²¹¹, I¹³¹,I¹²⁵, Y⁹⁰, Re¹⁸⁶, Re¹⁸⁸, Sm¹⁵³, Bi²¹², P³² and radioactive isotopes ofLu.

Conjugates of the antibody and cytotoxic agent may be made using avariety of bifunctional protein coupling agents such asN-succinimidyl-3-(2-pyridyldithiol) propionate (SPDP),succinimidyl-4-(N-maleimidomethyl)cyclohexane-1-carboxylate,iminothiolane (IT), bifunctional derivatives of imidoesters (such asdimethyl adipimidate HCL), active esters (such as disuccinimidylsuberate), aldehydes (such as glutareldehyde), bis-azido compounds (suchas bis (p-azidobenzoyl) hexanediamine), bis-diazonium derivatives (suchas bis-(p-diazoniumbenzoyl)-ethylenediamine), diisocyanates (such astolyene 2,6-diisocyanate), and bis-active fluorine compounds (such as1,5-difluoro-2,4-dinitrobenzene). For example, a ricin immunotoxin canbe prepared as described in Vitetta et al. Science 238: 1098 (1987).Carbon-14-labeled 1-isothiocyanatobenzyl-3-methyldiethylenetriaminepentaacetic acid (MX-DTPA) is an exemplary chelating agent forconjugation of radionucleotide to the antibody. See WO94/11026. Thelinker may be a “cleavable linker” facilitating release of the cytotoxicdrug in the cell. For example, an acid-labile linker,peptidase-sensitive linker, dimethyl linker or disulfide-containinglinker (Chari et al. Cancer Research 52: 127-131 (1992)) may be used.

Alternatively, a fusion protein comprising the anti-ErbB2 antibody andcytotoxic agent may be made, e.g. by recombinant techniques or peptidesynthesis. Immunoconjugates of anti-ErbB2 antibody fused to a chemokine(e.g. RANTES) are described in WO98/33914).

In yet another embodiment, the antibody may be conjugated to a“receptor” (such streptavidin) for utilization in pretargeting whereinthe antibody-receptor conjugate is administered to the patient, followedby removal of unbound conjugate from the circulation using a clearingagent and then administration of a “ligand” (e.g. avidin) which isconjugated to a cytotoxic agent (e.g. a radionucleotide).

(x) Antibody Dependent Enzyme Mediated Prodrug Therapy (ADEPT)

The antibodies of the present invention may also be used in ADEPT byconjugating the antibody to a prodrug-activating enzyme which converts aprodrug (e.g. a peptidyl chemotherapeutic agent, see WO81/01145) to anactive drug. See, for example, WO 88/07378 and U.S. Pat. No. 4,975,278.

The enzyme component of the immunoconjugate useful for ADEPT includesany enzyme capable of acting on a prodrug in such a way so as to covertit into its more active, cytotoxic form.

Enzymes that are useful in the method of this invention include, but arenot limited to, alkaline phosphatase useful for convertingphosphate-containing prodrugs into free drugs; arylsulfatase useful forconverting sulfate-containing prodrugs into free drugs; cytosinedeaminase useful for converting non-toxic 5-fluorocytosine into theactive drug, 5-fluorouracil; proteases, such as serratia protease,thermolysin, subtilisin, carboxypeptidases and cathepsins (such ascathepsins B and L), that are useful for converting peptide-containingprodrugs into free drugs; D-alanylcarboxypeptidases, useful forconverting prodrugs that contain D-amino acid substituents;carbohydrate-cleaving enzymes such as β-galactosidase and neuraminidaseuseful for converting glycosylated prodrugs into free drugs; β-lactamaseuseful for converting drugs derivatized with β-lactams into free drugs;and penicillin amidases, such as penicillin V amidase or penicillin Gamidase, useful for converting drugs derivatized at their aminenitrogens with phenoxyacetyl or phenylacetyl groups, respectively, intofree drugs. Alternatively, antibodies with enzymatic activity, alsoknown in the art as “abzymes”, can be used to convert the prodrugs ofthe invention into free active drugs (see, e.g., Massey, Nature 328:457-458 (1987)). Antibody-abzyme conjugates can be prepared as describedherein for delivery of the abzyme to a cell population.

The enzymes of this invention can be covalently bound to the anti-ErbB2antibodies by techniques well known in the art such as the use of theheterobifunctional crosslinking reagents discussed above. Alternatively,fusion proteins comprising at least the antigen binding region of anantibody of the invention linked to at least a functionally activeportion of an enzyme of the invention can be constructed usingrecombinant DNA techniques well known in the art (see, e.g., Neubergeret al., Nature, 312: 604-608 (1984).

(xi) Other Antibody Modifications

Other modifications of the antibody are contemplated herein. Forexample, the antibody may be linked to one of a variety ofnonproteinaceous polymers, e.g., polyethylene glycol, polypropyleneglycol, polyoxyalkylenes, or copolymers of polyethylene glycol andpolypropylene glycol. The antibody also may be entrapped inmicrocapsules prepared, for example, by coacervation techniques or byinterfacial polymerization (for example, hydroxymethylcellulose orgelatin-microcapsules and poly-(methylrnethacylate) microcapsules,respectively), in colloidal drug delivery systems (for example,liposomes, albumin microspheres, microemulsions, nano-particles andnanocapsules), or in macroemulsions. Such techniques are disclosed inRemington's Pharmaceutical Sciences, 16th edition, Oslo, A., Ed.,(1980).

The anti-ErbB2 antibodies disclosed herein may also be formulated asimmunoliposomes. Liposomes containing the antibody are prepared bymethods known in the art, such as described in Epstein et al., Proc.Natl. Acad. Sci. USA, 82:3688 (1985); Hwang et al., Proc. Natl. Acad.Sci. USA, 77:4030 (1980); U.S. Pat. Nos. 4,485,045 and 4,544,545; andWO97/38731 published Oct. 23, 1997. Liposomes with enhanced circulationtime are disclosed in U.S. Pat. No. 5,013,556.

Particularly useful liposomes can be generated by the reverse phaseevaporation method with a lipid composition comprisingphosphatidylcholine, cholesterol and PEG-derivatizedphosphatidylethanolamine (PEG-PE). Liposomes are extruded throughfilters of defined pore size to yield liposomes with the desireddiameter. Fab′ fragments of the antibody of the present invention can beconjugated to the liposomes as described in Martin et al. J. Biol. Chem.257: 286-288 (1982) via a disulfide interchange reaction. Achemotherapeutic agent is optionally contained within the liposome. SeeGabizon et al. J. National Cancer Inst. 81(19)1484 (1989).

Pharmaceutical Formulations

Therapeutic formulations of the ErbB antagonists of the presentinvention can be prepared as pharmaceutical formulations, using standardingredients and techniques as described, for example, in Remington'sPharmaceutical Sciences 16th edition, Osol, A. Ed. (1980). Thus,anti-ErbB antibodies are prepared for storage by mixing an antagonisthaving the desired degree of purity with optional pharmaceuticallyacceptable carriers, excipients or stabilizers, in the form oflyophilized formulations or aqueous solutions. Acceptable carriers,excipients, or stabilizers are nontoxic to recipients at the dosages andconcentrations employed, and include buffers such as phosphate, citrate,and other organic acids; antioxidants including ascorbic acid andmethionine; preservatives (such as octadecyldimethylbenzyl ammoniumchloride; hexamethonium chloride; benzalkonium chloride, benzethoniumchloride; phenol, butyl or benzyl alcohol; alkyl parabens such as methylor propyl paraben; catechol; resorcinol; cyclohexanol; 3-pentanol; andm-cresol); low molecular weight (less than about 10 residues)polypeptides; proteins, such as serum albumin, gelatin, orimmunoglobulins; hydrophilic polymers such as polyvinylpyrrolidone;amino acids such as glycine, glutamine, asparagine, histidine, arginine,or lysine; monosaccharides, disaccharides, and other carbohydratesincluding glucose, mannose, or dextrins; chelating agents such as EDTA;sugars such as sucrose, mannitol, trehalose or sorbitol; salt-formingcounter-ions such as sodium; metal complexes (e.g. Zn-proteincomplexes); and/or non-ionic surfactants such as TWEEN®, PLURONICS® orpolyethylene glycol (PEG). Preferred lyophilized anti-ErbB2 antibodyformulations are described in WO 97/04801, expressly incorporated hereinby reference.

The formulation herein may also contain more than one active compound asnecessary for the particular indication being treated, preferably thosewith complementary activities that do not adversely affect each other.For example, it may be desirable to further provide antibodies whichbind to EGFR, ErbB2 (e.g. an antibody which binds a different epitope onErbB2), ErbB3, ErbB4, or vascular endothelial factor (VEGF) in the oneformulation. Alternatively, or additionally, the composition may furthercomprise a chemotherapeutic agent, cytotoxic agent, cytokine, growthinhibitory agent, anti-hormonal agent, EGFR-targeted drug, tyrosinekinase inhibitor, immunosuppressive agent, anti-angiogenic agent, and/orcardioprotectant. Such molecules are suitably present in combination inamounts that are effective for the purpose intended.

The active ingredients may also be entrapped in microcapsules prepared,for example, by coacervation techniques or by interfacialpolymerization, for example, hydroxymethylcellulose orgelatin-microcapsules and poly-(methylmethacylate) microcapsules,respectively, in colloidal drug delivery systems (for example,liposomes, albumin microspheres, microemulsions, nano-particles andnanocapsules) or in macroemulsions. Such techniques are disclosed inRemington's Pharmaceutical Sciences, supra.

Sustained-release preparations may be prepared. Suitable examples ofsustained-release preparations include semipermeable matrices of solidhydrophobic polymers containing the antibody, which matrices are in theform of shaped articles, e.g. films, or microcapsules. Examples ofsustained-release matrices include polyesters, hydrogels (for example,poly(2-hydroxyethyl-methacrylate), or poly(vinylalcohol)), polylactides(U.S. Pat. No. 3,773,919), copolymers of L-glutamic acid and γethyl-L-glutamate, non-degradable ethylene-vinyl acetate, degradablelactic acid-glycolic acid copolymers such as the LUPRON DEPOT®(injectable microspheres composed of lactic acid-glycolic acid copolymerand leuprolide acetate), and poly-D-(−)-3-hydroxybutyric acid.

The formulations to be used for in vivo administration must be sterile.This is readily accomplished by filtration through sterile filtrationmembranes.

If the ErbB antagonist is a small organic molecule, it is preferablyformulated in a form suitable for oral administration, although liquidpreparations for injection or infusion administration are also suitable.

Pain Treatment with the ErbB Antagonist

The ErbB antagonists can be administered to human patients in accordwith known methods. Thus, for example, anti-ErbB (e.g. anti-ErbB2)antibodies can be administered intravenously, e.g., as a bolus or bycontinuous infusion over a period of time, or by intramuscular,intraperitoneal, intracerobrospinal, subcutaneous, intra-articular,intrasynovial, intrathecal, oral, topical, or inhalation routes.Intravenous or subcutaneous administration of the antibodies ispreferred.

Optimal dosage can be determined based upon dosing experiments inrelevant animal models and fine tuned in human clinical trials.Typically, an effective dose will reduce the patient's pain score by atleast 1, preferably by at least 2, more preferably by at least 3 grades,and preferably results in a pain score (on a 0 to 10 scale) of no morethan 5, more preferably no more than 4, even more preferably no morethan 3, most preferably no more than 2. The effective dose will alsodepend on the nature and severity of the initial pain.

The analgesic activity of a candidate ErbB antagonist is generallytested in a double-blind, randomized, placebo-controlled clinical trial.For general overview of the design of randomized controlled trials see,e.g. Jadad A R, Haynes R B. Med Decis Making 1998; 18:2-9.

Other therapeutic regimens may be combined with the administration ofthe ErbB antagonists, such as anti-ErbB2 antibodies. The combinedadministration includes coadministration, using separate formulations ora single pharmaceutical formulation, and consecutive administration ineither order, wherein preferably there is a time period while both (orall) active agents simultaneously exert their biological activities.

In one preferred embodiment, the patient is treated with two differentanti-ErbB2 antibodies. For example, the patient may be treated with afirst anti-ErbB2 antibody which blocks ligand activation of an ErbB oran antibody having a biological characteristic of monoclonal antibody2C4 as well as a second anti-ErbB2 antibody which is growth inhibitory(e.g. HERCEPTIN®) or an anti-ErbB2 antibody which induces apoptosis ofan ErbB2-overexpressing cell (e.g. 7C2, 7F3 or humanized variantsthereof). Preferably such combined therapy results in a synergistictherapeutic effect. One may, for instance, treat the patient withHERCEPTIN® and thereafter treat with rhuMAb 2C4, e.g. where the patientdoes not respond to HERCEPTIN® therapy. In another embodiment, thepatient may first be treated with rhuMAb 2C4 and then receive HERCEPTIN®therapy. In yet a further embodiment, the patient may be treated withboth rhuMAb 2C4 and HERCEPTIN® simultaneously.

It may also be desirable to combine administration of the anti-ErbB2antibody or antibodies, with administration of an antibody directedagainst EGFR, ErbB3, ErbB4, or vascular endothelial growth factor(VEGF).

In one embodiment, the treatment of the present invention involves thecombined administration of an anti-ErbB2 antibody (or antibodies) andone or more chemotherapeutic agents, cytotoxic agents, or growthinhibitory agents, including coadministration of cocktails of differentchemotherapeutic agents. Preparation and dosing schedules for suchchemotherapeutic agents may be used according to manufacturers'instructions or as determined empirically by the skilled practitioner.Preparation and dosing schedules for such chemotherapy are alsodescribed in Chemotherapy Service Ed., M. C. Perry, Williams & Wilkins,Baltimore, Md. (1992).

The antibody may be combined with an anti-hormonal compound; e.g., ananti-estrogen compound such as tamoxifen; an anti-progesterone such asonapristone (see, EP 616 812); or an anti-androgen such as flutamide, indosages known for such molecules.

Sometimes, it may be beneficial to also coadminister a cardioprotectant(to prevent or reduce myocardial dysfunction associated with thetherapy) or one or more cytokines to the patient. One may alsocoadminister an anti-angiogenic agent. In addition to the abovetherapeutic regimes, the patient may be subjected to surgery, radiationtherapy, or phototherapy.

The anti-ErbB2 antibodies herein may also be combined with anEGFR-targeted drug, tyrosine kinase inhibitor and/or immunosuppressiveagent, such as those discussed above in the definitions sectionresulting in a complementary, and potentially synergistic, therapeuticeffect.

Suitable dosages for any of the above coadministered agents are thosepresently used and may be lowered due to the combined action (synergy)of the agent and anti-ErbB2 antibody.

As discussed above, for the prevention or treatment of pain, theappropriate dosage of antibody will depend on the type of and severityof pain to be treated, whether the antibody is administered forpreventive or therapeutic purposes, previous therapy, the patient'sclinical history and response to the antibody, and the discretion of theattending physician. The antibody is suitably administered to thepatient at one time or over a series of treatments. Depending on thetype and severity of the disease, about 1 μg/kg to 15 mg/kg (e.g.preferably about 0.1 or 0.5 to about 20 or about 30 mg/kg) of antibodyis an initial candidate dosage for administration to the patient,whether, for example, by one or more separate administrations, or bycontinuous infusion. A typical daily dosage might range from about 1μg/kg to 100 mg/kg or more, depending on the factors mentioned above.For repeated administrations over several days or longer, depending onthe condition, the treatment is sustained until a desired suppression ofdisease symptoms occurs. The preferred dosage of the antibody will be inthe range from about 0.5 mg/kg to about 30 mg/kg. Thus, one or moredoses of about 0.5 mg/kg, 2.0 mg/kg, 4.0 mg/kg, 6 mg/kg, 8 mg/kg, 10mg/kg or 15 mg/kg (or any combination thereof) may be administered tothe patient. Such doses may be administered intermittently, e.g. everyweek, every three weeks, monthly or less frequently, for instance every3 or 4 months (e.g. such that the patient receives from about two toabout twenty, e.g. about six doses of the anti-ErbB2 antibody). Aninitial higher loading dose, followed by one or more lower doses may beadministered. An exemplary dosing regimen comprises administering aninitial loading dose of about 4 mg/kg, followed by a weekly maintenancedose of about 2 mg/kg of the anti-ErbB2 antibody. However, other dosageregimens may be useful. The progress of this therapy is easily monitoredby conventional techniques and assays.

While the antibody administered is preferably “naked” or “not conjugatedwith a cytotoxic agent,” in certain embodiments, an immunoconjugatecomprising the anti-ErbB (e.g. anti-ErbB2) antibody conjugated with acytotoxic agent is administered to the patient. Preferably, theimmunoconjugate and/or ErbB2 protein to which it is bound is/areinternalized by the cell, resulting in increased therapeutic efficacy ofthe immunoconjugate. In a preferred embodiment, the cytotoxic agenttargets or interferes with nucleic acid in a cell. Examples of suchcytotoxic agents include maytansinoids, calicheamicins, ribonucleasesand DNA endonucleases.

Aside from administration of the antibody protein to the patient, thepresent application contemplates administration of the antibody by genetherapy. Such administration of nucleic acid encoding the antibody isencompassed by the expression “administering a therapeutically effectiveamount of an antibody”. See, for example, WO96/07321 published Mar. 14,1996 and WO01/56604 published Aug. 9, 2001 concerning antibodies to HER2administered by gene therapy.

There are two major approaches to getting the nucleic acid (optionallycontained in a vector) into the patient's cells; in vivo and ex vivo.For in vivo delivery the nucleic acid is injected directly into thepatient, usually at the site where the antibody is required. For ex vivotreatment, the patient's cells are removed, the nucleic acid isintroduced into these isolated cells and the modified cells areadministered to the patient either directly or, for example,encapsulated within porous membranes which are implanted into thepatient (see, e.g. U.S. Pat. Nos. 4,892,538 and 5,283,187). There are avariety of techniques available for introducing nucleic acids intoviable cells. The techniques vary depending upon whether the nucleicacid is transferred into cultured cells in vitro, or in vivo in thecells of the intended host. Techniques suitable for the transfer ofnucleic acid into mammalian cells in vitro include the use of liposomes,electroporation, microinjection, cell fusion, DEAE-dextran, the calciumphosphate precipitation method, etc. A commonly used vector for ex vivodelivery of the gene is a retrovirus.

The currently preferred in vivo nucleic acid transfer techniques includetransfection with viral vectors (such as adenovirus, Herpes simplex Ivirus, or adeno-associated virus) and lipid-based systems (useful lipidsfor lipid-mediated transfer of the gene are DOTMA, DOPE and DC-Chol, forexample). In some situations it is desirable to provide the nucleic acidsource with an agent that targets the target cells, such as an antibodyspecific for a cell surface membrane protein or the target cell, aligand for a receptor on the target cell, etc. Where liposomes areemployed, proteins which bind to a cell surface membrane proteinassociated with endocytosis may be used for targeting and/or tofacilitate uptake, e.g. capsid proteins or fragments thereof tropic fora particular cell type, antibodies for proteins which undergointernalization in cycling, and proteins that target intracellularlocalization and enhance intracellular half-life. The technique ofreceptor-mediated endocytosis is described, for example, by Wu et al.,J. Biol. Chem. 262:4429-4432 (1987); and Wagner et al., Proc. Natl.Acad. Sci. USA 87:3410-3414 (1990). For review of the currently knowngene marking and gene therapy protocols see Anderson et al., Science256:808-813 (1992). See also WO 93/25673 and the references citedtherein.

Deposit of Materials

The following hybridoma cell lines have been deposited with the AmericanType Culture Collection (ATCC), 10801 University Boulevard, Manassas,Va. 20110-2209, USA (ATCC):

Antibody Designation ATCC No. Deposit Date 7C2 ATCC HB-12215 Oct. 17,1996 7F3 ATCC HB-12216 Oct. 17, 1996 4D5 ATCC CRL 10463 May 24, 1990 2C4ATCC HB-12697 Apr. 8, 1999

Further details of the invention are illustrated by the followingnon-limiting Examples. The disclosures of all citations in thespecification are expressly incorporated herein by reference.

Example 1 Production and Characterization of Monoclonal Antibody 2C4

The murine monoclonal antibodies 2C4, 7F3 and 4D5 which specificallybind the extracellular domain of ErbB2 were produced as described inFendly et al., Cancer Research 50:1550-1558 (1990). Briefly, NIH3T3/HER2-3₄₀₀ cells (expressing approximately 1×10⁵ ErbB2molecules/cell) produced as described in Hudziak et al Proc. Natl. Acad.Sci. (USA) 84:7158-7163 (1987) were harvested with phosphate bufferedsaline (PBS) containing 25 mM EDTA and used to immunize BALB/c mice. Themice were given injections i.p. of 10⁷ cells in 0.5 ml PBS on weeks 0,2, 5 and 7. The mice with antisera that immunoprecipitated ³²P-labeledErbB2 were given i.p. injections of a wheat germ agglutinin-Sepharose(WGA) purified ErbB2 membrane extract on weeks 9 and 13. This wasfollowed by an i.v. injection of 0.1 ml of the ErbB2 preparation and thesplenocytes were fused with mouse myeloma line X63-Ag8.653.

Hybridoma supernatants were screened for ErbB2-binding by ELISA andradioimmunoprecipitation.

The ErbB2 epitopes bound by monoclonal antibodies 4D5, 7F3 and 2C4 weredetermined by competitive binding analysis (Fendly et al. CancerResearch 50:1550-1558 (1990)). Cross-blocking studies were done onantibodies by direct fluorescence on intact cells using the PANDEX®Screen Machine to quantitate fluorescence. Each monoclonal antibody wasconjugated with fluorescein isothiocyanate (FITC), using establishedprocedures (Wofsy et al. Selected Methods in Cellular Immunology, p.287, Mishel and Schiigi (eds.) San Francisco: W.J. Freeman Co. (1980)).Confluent monolayers of NIH 3T3/HER2-3₄₀₀ cells were trypsinized, washedonce, and resuspended at 1.75×10⁶ cell/ml in cold PBS containing 0.5%bovine serum albumin (BSA) and 0.1% NaN₃. A final concentration of 1%latex particles (IDC, Portland, Oreg.) was added to reduce clogging ofthe PANDEX® plate membranes. Cells in suspension, 20 μl, and 20 μl ofpurified monoclonal antibodies (100 μg/ml to 0.1 μg/ml) were added tothe PANDEX® plate wells and incubated on ice for 30 minutes. Apredetermined dilution of FITC-labeled monoclonal antibodies in 20 μlwas added to each well, incubated for 30 minutes, washed, and thefluorescence was quantitated by the PANDEX®. Monoclonal antibodies wereconsidered to share an epitope if each blocked binding of the other by50% or greater in comparison to an irrelevant monoclonal antibodycontrol. In this experiment, monoclonal antibodies 4D5, 7F3 and 2C4 wereassigned epitopes I, G/F and F, respectively.

The growth inhibitory characteristics of monoclonal antibodies 2C4, 7F3and 4D5 were evaluated using the breast tumor cell line, SK-BR-3 (seeHudziak et al. Molec. Cell. Biol. 9(3):1165-1172 (1989)). Briefly,SK-BR-3 cells were detached by using 0.25% (vol/vol) trypsin andsuspended in complete medium at a density of 4×10⁵ cells per ml.Aliquots of 100 μl (4×10⁴ cells) were plated into 96-well microdilutionplates, the cells were allowed to adhere, and 100 μl of media alone ormedia containing monoclonal antibody (final concentration 5 μg/ml) wasthen added. After 72 hours, plates were washed twice with PBS (pH 7.5),stained with crystal violet (0.5% in methanol), and analyzed forrelative cell proliferation as described in Sugarman et al. Science230:943-945 (1985). Monoclonal antibodies 2C4 and 7F3 inhibited SK-BR-3relative cell proliferation by about 20% and about 38%, respectively,compared to about 56% inhibition achieved with monoclonal antibody 4D5.

Monoclonal antibodies 2C4, 4D5 and 7F3 were evaluated for their abilityto inhibit HRG-stimulated tyrosine phosphorylation of proteins in theM_(r) 180,000 range from whole-cell lysates of MCF7 cells (Lewis et al.Cancer Research 56:1457-1465 (1996)). MCF7 cells are reported to expressall known ErbBs, but at relatively low levels. Since ErbB2, ErbB3, andErbB4 have nearly identical molecular sizes, it is not possible todiscern which protein is becoming tyrosine phosphorylated whenwhole-cell lysates are evaluated by Western blot analysis.

However, these cells are ideal for HRG tyrosine phosphorylation assaysbecause under the assay conditions used, in the absence of exogenouslyadded HRG, they exhibit low to undetectable levels of tyrosinephosphorylation proteins in the M_(r) 180,000 range.

MCF7 cells were plated in 24-well plates and monoclonal antibodies toErbB2 were added to each well and incubated for 30 minutes at roomtemperature; then rHRGβ1₁₇₇₋₂₄₄ was added to each well to a finalconcentration of 0.2 nM, and the incubation was continued for 8 minutes.Media was carefully aspirated from each well, and reactions were stoppedby the addition of 100 μl of SDS sample buffer (5% SDS, 25 mM DTT, and25 mM Tris-HCl, pH 6.8). Each sample (25 μl) was electrophoresed on a4-12% gradient gel (Novex) and then electrophoretically transferred topolyvinylidene difluoride membrane. Antiphosphotyrosine (4G10, from UBI,used at 1 μg/ml) immunoblots were developed, and the intensity of thepredominant reactive band at M_(r)-180,000 was quantified by reflectancedensitometry, as described previously (Holmes et al. Science256:1205-1210 (1992); Sliwkowski et al. J. Biol. Chem. 269:14661-14665(1994)).

Monoclonal antibodies 2C4, 7F3, and 4D5, significantly inhibited thegeneration of a HRG-induced tyrosine phosphorylation signal at M_(r)180,000. In the absence of HRG, none of these antibodies were able tostimulate tyrosine phosphorylation of proteins in the M_(r) 180,000range. Also, these antibodies do not cross-react with EGFR (Fendly etal. Cancer Research 50:1550-1558 (1990)), ErbB3, or ErbB4. Antibodies2C4 and 7F3 significantly inhibited HRG stimulation of p180 tyrosinephosphorylation to <25% of control. Monoclonal antibody 4D5 was able toblock HRG stimulation of tyrosine phosphorylation by ˜50%. FIG. 2A showsdose-response curves for 2C4 or 7F3 inhibition of HRG stimulation ofp180 tyrosine phosphorylation as determined by reflectance densitometry.Evaluation of these inhibition curves using a 4-parameter fit yielded anIC₅₀ of 2.8±0.7 nM and 29.0±4.1 nM for 2C4 and 7F3, respectively.

Inhibition of HRG binding to MCF7 breast tumor cell lines by anti-ErbB2antibodies was performed with monolayer cultures on ice in a24-well-plate format (Lewis et al. Cancer Research 56:1457-1465 (1996)).Anti-ErbB2 monoclonal antibodies were added to each well and incubatedfor 30 minutes ¹²⁵I-labeled rHRGβ1₁₇₇₋₂₂₄ (25 pm) was added, and theincubation was continued for 4 to 16 hours. FIG. 2B providesdose-response curves for 2C4 or 7F3 inhibition of HRG binding to MCF7cells. Varying concentrations of 2C4 or 7F3 were incubated with MCF7cells in the presence of ¹²⁵I-labeled rHRGβ1, and the inhibition curvesare shown in FIG. 2B. Analysis of these data yielded an IC₅₀ of 2.4±0.3nM and 19.0±7.3 nM for 2C4 and 7F3, respectively. A maximum inhibitionof ˜74% for 2C4 and 7F3 were in agreement with the tyrosinephosphorylation data.

To determine whether the effect of the anti-ErbB2 antibodies observed onMCF7 cells was a general phenomenon, human tumor cell lines wereincubated with 2C4 or 7F3 and the degree of specific ¹²⁵I-labeled rHRGβ1binding was determined (Lewis et al. Cancer Research 56:1457 1465(1996)). The results from this study are shown in FIG. 3. Binding of¹²¹I-labeled rHRGβ1 could be significantly inhibited by either 2C4 or7F3 in all cell lines, with the exception of the breast cancer cell lineMDA-MB-468, which has been reported to express little or no ErbB2. Theremaining cell lines are reported to express ErbB2, with the level ofErbB2 expression varying widely among these cell lines. In fact, therange of ErbB2 expression in the cell lines tested varies by more than 2orders of magnitude. For example, BT-20, MCF7, and Caov3 express ˜10⁴ErbB2 receptors/cell, whereas BT-474 and SK-BR-3 express ˜10⁶ ErbB2receptors/cell. Given the wide range of ErbB2 expression in these cellsand the data above, it was concluded that the interaction between ErbB2and ErbB3 or ErbB4, was itself a high-affinity interaction that takesplace on the surface of the plasma membrane.

The growth inhibitory effects of monoclonal antibodies 2C4 and 4D5 onMDA-MB-175 and SK-BR-3 cells in the presence or absence of exogenousrHRGβ1 was assessed (Schaefer et al. Oncogene 15:1385-1394 (1997)).ErbB2 levels in MDA-MB-175 cells are 4-6 times higher than the levelfound in normal breast epithelial cells and the ErbB2-ErbB4 receptor isconstitutively tyrosine phosphorylated in MDA-MB-175 cells. MDA-MB-175cells were treated with an anti-ErbB2 monoclonal antibodies 2C4 and 4D5(10 μg/mL) for 4 days. In a crystal violet staining assay, incubationwith 2C4 showed a strong growth inhibitory effect on this cell line(FIG. 4A). Exogenous HRG did not significantly reverse this inhibition.On the other hand 2C4 revealed no inhibitory effect on the ErbB2overexpressing cell line SK-BR-3 (FIG. 4B). Monoclonal antibody 2C4 wasable to inhibit cell proliferation of MDA-MB-175 cells to a greaterextent than monoclonal antibody 4D5, both in the presence and absence ofexogenous HRG. Inhibition of cell proliferation by 4D5 is dependent onthe ErbB2 expression level (Lewis et al. Cancer Immunol. Immunother.37:255-263 (1993)). A maximum inhibition of 66% in SK-BR-3 cells couldbe detected (FIG. 4B). However this effect could be overcome byexogenous HRG.

Example 2 HRG Dependent Association of ErbB2 with ErbB3 is Blocked byMonoclonal Antibody 2C4

The ability of ErbB3 to associate with ErbB2 was tested in aco-immunoprecipitation experiment. 1.0×10⁶ MCF7 or SK-BR-3 cells wereseeded in six well tissue culture plates in 50:50 DMEM/Ham's F12 mediumcontaining 10% fetal bovine serum (FBS) and 10 mM HEPES, pH 7.2 (growthmedium), and allowed to attach overnight. The cells were starved for twohours in growth medium without serum prior to beginning the experiment.

The cells were washed briefly with phosphate buffered saline (PBS) andthen incubated with either 100 nM of the indicated antibody diluted in0.2% w/v bovine serum albumin (BSA), RPMI medium, with 10 mM HEPES, pH7.2 (binding buffer), or with binding buffer alone (control). After onehour at room temperature, HRG was added to a final concentration of 5 nMto half the wells (+). A similar volume of binding buffer was added tothe other wells (−). The incubation was continued for approximately 10minutes.

Supernatants were removed by aspiration and the cells were lysed inRPMI, 10 mM HEPES, pH 7.2, 1.0% v/v TRITON X-100®, 1.0% w/v CHAPS (lysisbuffer), containing 0.2 mM PMSF, 10 μg/ml leupeptin, and 10 TU/mlaprotinin. The lysates were cleared of insoluble material bycentrifugation.

ErbB2 was immunoprecipitated using a monoclonal antibody covalentlycoupled to an affinity gel (Affi-Prep 10, Bio-Rad). This antibody (Ab-3,Oncogene Sciences) recognizes a cytoplasmic domain epitope.Immunoprecipitation was performed by adding 10 μl of gel slurrycontaining approximately 8.5 μg of immobilized antibody to each lysate,and the samples were allowed to mix at room temperature for two hours.The gels were then collected by centrifugation. The gels were washedbatchwise three times with lysis buffer to remove unbound material. SDSsample buffer was then added and the samples were heated briefly in aboiling water bath.

Supernatants were run on 4-12% polyacrylamide gels and electroblottedonto nitrocellulose membranes. The presence of ErbB3 was assessed byprobing the blots with a polyclonal antibody against a cytoplasmicdomain epitope thereof (c-17, Santa Cruz Biotech). The blots werevisualized using a chemiluminescent substrate (ECL, Amersham).

As shown in the control lanes of FIGS. 5A and 5B, for MCF7 and SK-BR-3cells, respectively, ErbB3 was present in an ErbB2 immunoprecipitateonly when the cells were stimulated with HRG. If the cells were firstincubated with monoclonal antibody 2C4, the ErbB3 signal was abolishedin MCF7 cells (FIG. 5A, lane 2C4+) or substantially reduced in SK-BR-3cells (FIG. 5B, lane 2C4+). As shown in FIGS. 5A-B, monoclonal antibody2C4 blocks heregulin dependent association of ErbB3 with ErbB2 in bothMCF7 and SK-BR-3 cells substantially more effectively than HERCEPTIN®.Preincubation with HERCEPTIN® decreased the ErbB3 signal in MCF7 lysatesbut had little or no effect on the amount of ErbB3 co-precipitated fromSK-BR-3 lysates. Preincubation with an antibody against the EGF receptor(Ab-1, Oncogene Sciences) had no effect on the ability of ErbB3 toco-immunoprecipitate with ErbB2 in either cell line.

Example 3 Humanized 2C4 Antibodies

The variable domains of murine monoclonal antibody 2C4 were first clonedinto a vector which allows production of a mouse/human chimeric Fabfragment. Total RNA was isolated from the hybridoma cells using aStratagene RNA extraction kit following manufacturer's protocols. Thevariable domains were amplified by RT-PCR, gel purified, and insertedinto a derivative of a pUC119-based plasmid containing a human kappaconstant domain and human C_(H)1 domain as previously described (Carteret al. PNAS (USA) 89:4285 (1992); and U.S. Pat. No. 5,821,337). Theresultant plasmid was transformed into E. coli strain 16C9 forexpression of the Fab fragment. Growth of cultures, induction of proteinexpression, and purification of Fab fragment were as previouslydescribed (Werther et al. J. Immunol. 157:4986-4995 (1996); Presta etal. Cancer Research 57: 4593-4599 (1997)).

Purified chimeric 2C4 Fab fragment was compared to the murine parentantibody 2C4 with respect to its ability to inhibit ¹²⁵I-HRG binding toMCF7 cells and inhibit rHRG activation of p180 tyrosine phosphorylationin MCF7 cells. As shown in FIG. 6A, the chimeric 2C4 Fab fragment isvery effective in disrupting the formation of the high affinityErbB2-ErbB3 binding site on the human breast cancer cell line, MCF7. Therelative IC₅₀ value calculated for intact murine 2C4 is 4.0±0.4 nM,whereas the value for the Fab fragment is 7.7±1.1 nM. As illustrated inFIG. 6B, the monovalent chimeric 2C4 Fab fragment is very effective indisrupting HRG-dependent ErbB2-ErbB3 activation. The IC₅₀ valuecalculated for intact murine monoclonal antibody 2C4 is 6.0±2 nM,whereas the value for the Fab fragment is 15.0±2 nM.

DNA sequencing of the chimeric clone allowed identification of the CDRresidues (Kabat et al., Sequences of Proteins of Immunological Interest,5^(th) Ed. Public Health Service, National Institutes of Health,Bethesda, Md. (1991)) (FIGS. 7A and B). Using oligonucleotidesite-directed mutagenesis, all six of these CDR regions were introducedinto a complete human framework (V_(L) kappa subgroup I and V_(H)subgroup III) contained on plasmid VX4 as previously described (Prestaet al., Cancer Research 57: 4593-4599 (1997)). Protein from theresultant “CDR-swap” was expressed and purified as above. Bindingstudies were performed to compare the two versions. Briefly, a NUNCMAXISORP® plate was coated with 1 microgram per ml of ErbB2extracellular domain (ECD; produced as described in WO 90/14357) in 50mM carbonate buffer, pH 9.6, overnight at 4° C., and then blocked withELISA diluent (0.5% BSA, 0.05% polysorbate 20, PBS) at room temperaturefor 1 hour. Serial dilutions of samples in ELISA diluent were incubatedon the plates for 2 hours. After washing, bound Fab fragment wasdetected with biotinylated murine anti-human kappa antibody (ICN 634771)followed by streptavidin-conjugated horseradish peroxidase (Sigma) andusing 3,3′,5,5′-tetramethyl benzidine (Kirkegaard & Perry Laboratories,Gaithersburg, Md.) as substrate. Absorbance was read at 450 nm. As shownin FIG. 8A, all binding was lost on construction of the CDR-swap humanFab fragment.

To restore binding of the humanized Fab, mutants were constructed usingDNA from the CDR-swap as template. Using a computer generated model(FIG. 9), these mutations were designed to change human framework regionresidues to their murine counterparts at positions where the changemight affect CDR conformations or the antibody-antigen interface.Mutants are shown in Table 2.

TABLE 2 Designation of Humanized 2C4 FR Mutations Mutant no. Frameworkregion (FR) substitutions 560 ArgH71Val 561 AspH73Arg 562 ArgH71Val,AspH73Arg 568 ArgH71Val, AspH73Arg, AlaH49Gly 569 ArgH71Val, AspH73Arg,PheH67Ala 570 ArgH71Val, AspH73Arg, AsnH76Arg 571 ArgH71Val, AspH73Arg,LeuH78Val 574 ArgH71Val, AspH73Arg, IleH69Leu 56869 ArgH71Val,AspH73Arg, AlaH49Gly, PheH67Ala

Binding curves for the various mutants are shown in FIGS. 8A-C.Humanized Fab version 574, with the changes ArgH71Val, AspH73Arg andIleH69Leu, appears to have binding restored to that of the originalchimeric 2C4 Fab fragment. Additional FR and/or CDR residues, such asL2, L54, L55, L56, H35 and/or H48, may be modified (e.g. substituted asfollows—IleL2Thr; ArgL54Leu; TyrL55Glu; ThrL56Ser; AspH35Ser; andValH48Ile) in order to further refine or enhance binding of thehumanized antibody. Alternatively, or additionally, the humanizedantibody may be affinity matured (see above) in order to further improveor refine its affinity and/or other biological activities.

Humanized 2C4 version 574 was affinity matured using a phage-displaymethod. Briefly, humanized 2C4.574 Fab was cloned into a phage displayvector as a geneIII fusion. When phage particles are induced byinfection with M13KO7 helper phage, this fusion allows the Fab to bedisplayed on the N-terminus of the phage tail-fiber protein, geneIII(Baca et J Biol. Chem. 272:10678 (1997)).

Individual libraries were constructed for each of the 6 CDRs identifiedabove. In these libraries, the amino acids in the CDRs which wereidentified using a computer generated model (FIG. 9) as beingpotentially significant in binding to ErbB2 were randomized using oligoscontaining “NNS” as their codons. The libraries were then panned againstErbB2 ECD coated on NUNC MAXISORP™ plates with 3% dry milk in PBS with0.2% TWEEN 20® (MPBST) used in place of all blocking solutions. In orderto select for phage with affinities higher than that of 2C4.574, inpanning rounds 3, 4, and 5, soluble ErbB2 ECD or soluble Fab 2C4.574 wasadded during the wash steps as competitor. Wash times were extended to 1hour at room temperature.

After 5 rounds of panning, individual clones were again analyzed byphage-ELISA. Individual clones were grown in Costar 96-well U-bottomedtissue culture plates, and phage were induced by addition of helperphage. After overnight growth, E. coli cells were pelleted, and thephage-containing supernates were transfered to 96-well plates where thephage were blocked with MPBST for 1 hr at room temperature. NUNCMAXISORP™ plates coated with ErbB2 ECD were also blocked with MPBST asabove. Blocked phage were incubated on the plates for 2 hours. Afterwashing, bound phage were detected usinghorseradish-peroxidase-conjugated anti-M13 monoclonal antibody (AmershamPharmacia Biotech, Inc. 27-9421-01) diluted 1:5000 in MPBST, followed by3,3′,5,5′,-tetramethyl benzidine as substrate. Absorbance was read at450 nm.

The 48 clones from each library which gave the highest signals were DNAsequenced. Those clones whose sequences occurred the most frequentlywere subcloned into the vector described above which allows expressionof soluble Fabs. These Fabs were induced, proteins purified and thepurified Fabs were analyzed for binding by ELISA as described above andthe binding was compared to that of the starting humanized 2C4.574version.

After interesting mutations in individual CDRs were identified,additional mutants which were various combinations of these wereconstructed and tested as above. Mutants which gave improved bindingrelative to 574 are described in Table 3.

TABLE 3 Designation of mutants derived from affinity maturation of2C4.574 Mutant Name Change from 574 Mutant/574* H3.A1 serH99trp,metH34leu 0.380 L2.F5 serL50trp, tyrL53gly, metH34leu 0.087 H1.3.B3thrH28gln, thrH30ser, metH34leu 0.572 L3.G6 tyrL92pro, ileL93lys,metH34leu 0.569 L3.G11 tyrL92ser, ileL93arg, tyrL94gly, metH34leu 0.561L3.29 tyrL92phe, tyrL96asn, metH34leu 0.552 L3.36 tyrL92phe, tyrL94leu,tyrL96pro, metH34leu 0.215 654 serL50trp, metH34leu 0.176 655 metH34ser0.542 659 serL50trp, metH34ser 0.076 L2.F5.H3.A1 serL50trp, tyrL53gly,metH34leu, serH99trp 0.175 L3G6.H3.A1 tyrL92pro, ileL93lys, metH34leu,serH99trp 0.218 H1.3.B3.H3.A1 thrH28gln, thrH30ser, metH34leu, serH99trp0.306 L3.G11.H3.A1 tyrL92ser, ileL93arg, tyrL94gly, metH34leu, serH99trp0.248 654.H3.A1 serL50trp, metH34leu, serH99trp 0.133 654.L3.G6serL50trp, metH34leu, tyrL92pro, ileL93lys 0.213 654.L3.29 serL50trp,metH34leu, tyrL92phe, tyrL96asn 0.236 654.L3.36 serL50trp, metH35leu,tyrL92phe, tyrL94leu, tyrL96pro 0.141 *Ratio of the amount of mutantneeded to give the mid-OD of the standard curve to the amount of 574needed to give the mid-OD of the standard curve in an Erb2-ECD ELISA. Anumber less than 1.0 indicates that the mutant binds Erb2 better than574 binds.

The following mutants have also been constructed, and are currentlyunder evaluation:

659.L3.G6 serL50trp, metH34ser, tyrL92pro, ileL93lys 659.L3.G11serL50trp, metH34ser, tyrL92ser, ileL93arg, tyrL94gly 659.L3.29serL50trp, metH34ser, tyrL92phe, tyrL96asn 659.L3.36 serL50trp,metH34ser, tyrL92phe, tyrL94leu, tyrL96pro L2F5.L3G6 serL50trp,tyrL53gly, metH34leu, tyrL92pro, ileL93lys L2F5.L3G11 serL50trp,tyrL53gly, metH34leu, tyrL92ser, ileL93arg, tyrL94gly L2F5.L29serL50trp, tyrL53gly, metH34leu, tyrL92phe, tyrL96asn L2F5.L36serL50trp, tyrL53gly, metH34leu, tyrL92phe, tyrL94leu, tyrL96proL2F5.L3G6.655 serL50trp, tyrL53gly, metH35ser, tyrL92pro, ileL93lysL2F5.L3G11.655 serL50trp, tyrL53gly, metH34ser, tyrL92ser, ileL93arg,tyrL94gly L2F5.L29.655 serL50trp, tyrL53gly, metH34ser, tyrL92phe,tyrL96asn L2F5.L36.655 serL50trp, tyrL53gly, metH34ser, tyrL92phe,tyrL94leu, tyrL96pro.

The following mutants, suggested by a homology scan, are currently beingconstructed:

678 thrH30ala 679 thrH30ser 680 lysH64arg 681 leuH96val 682 thrL97ala683 thrL97ser 684 tyrL96phe 685 tyrL96ala 686 tyrL91phe 687 thrL56ala688 glnL28ala 689 glnL28glu

The preferred amino acid at H34 would be methionine. A change to leucinemight be made if there were found to be oxidation at this position.

AsnH52 and asnH53 were found to be strongly preferred for binding.Changing these residues to alanine or aspartic acid dramaticallydecreased binding.

An intact antibody comprising the variable light and heavy domains ofhumanized version 574 with a human IgG1 heavy chain constant region hasbeen prepared (see U.S. Pat. No. 5,821,337). The intact antibody isproduced by Chinese Hamster Ovary (CHO) cells. That molecule isdesignated rhuMAb 2C4 herein.

Example 4 Monoclonal Antibody 2C4 Blocks EGF, TGF-α or HRG MediatedActivation of MAPK

Many growth factor receptors signal through the mitogen-activatedprotein kinase (MAPK) pathway. These dual specificity kinases are one ofthe key endpoints in signal transduction pathways that ultimatelytriggers cancer cells to divide. The ability of monoclonal antibody 2C4or HERCEPTIN® to inhibit EGF, TGF-α or HRG activation of MAPK wasassessed in the following way.

MCF7 cells (10⁵ cells/well) were plated in serum containing media in12-well cell culture plates. The next day, the cell media was removedand fresh media containing 0.1% serum was added to each well. Thisprocedure was then repeated the following day and prior to assay themedia was replaced with serum-free binding buffer (Jones et al. J. Biol.Chem. 273:11667-74 (1998); and Schaefer et al. J. Biol. Chem. 274:859-66(1999)). Cells were allowed to equilibrate to room temperature and thenincubated for 30 minutes with 0.5 mL of 200 nM HERCEPTIN® or monoclonalantibody 2C4. Cells were then treated with 1 nM EGF, 1 nM TGF-α or 0.2nM HRG for 15 minutes. The reaction was stopped by aspirating the cellmedium and then adding 0.2 mL SDS-PAGE sample buffer containing 1% DTT.MAPK activation was assessed by Western blotting using an anti-activeMAPK antibody (Promega) as described previously (Jones et al. J. Biol.Chem. 273:11667-74 (1998)).

As shown in FIG. 10, monoclonal antibody 2C4 significantly blocks EGF,TGF-α and HRG mediated activation of MAPK to a greater extent thanHERCEPTIN®. These data suggest that monoclonal antibody 2C4 binds to asurface of ErbB2 that is used for its association with either EGFR orErbB3 and thus prevents the formation of the signaling receptor complex.

Monoclonal antibody 2C4 was also shown to inhibit heregulin(HRG)-dependent Akt activation. Activation of the PI3 kinase signaltransduction pathway is important for cell survival (Carraway et al. J.Biol. Chem. 270: 7111-6 (1995)). In tumor cells, PI3 kinase activationmay play a role in the invasive phenotype (Tan et al. Cancer Research.59: 1620-1625, (1999)). The survival pathway is primarily mediated bythe serine/threonine kinase AKT (Bos et al. Trends Biochem Sci. 20:441-442 (1995). Complexes formed between ErbB2 and either ErbB3 or EGFRcan initiate these pathways in response to heregulin or EGF,respectively (Olayioye et al. Mol. & Cell. Biol. 18: 5042-51 (1998);Karunagaran et al., EMBO Journal. 15: 254-264 (1996); and Krymskaya etal. Am. J. Physiol. 276: L246-55 (1999)). Incubation of MCF7 breastcancer cells with 2C4 inhibits heregulin-mediated AKT activation.Moreover, the basal level of AKT activation present in the absence ofheregulin addition is further reduced by the addition of 2C4. These datasuggest that 2C4 may inhibit ErbB ligand-activation of PI3 kinase andthat this inhibition may lead to apoptosis. The increased sensitivity toapoptosis may manifest in a greater sensitivity of tumor cells to thetoxic effects of chemotherapy.

Thus, monoclonal antibody 2C4 inhibits ligand initiated ErbB signalingthrough two major signal transduction pathways—MAP Kinase (a majorproliferative pathway) and P13 kinase (a major survival/anti-apoptoticpathway).

Example 5 rhuMAb 2C4 for Treating Pain Cancer-Associated Pain

A 43 years old male patient diagnosed with lipsarcoma and receivingchemotherapy for two years was hospitalized with a deep wound in theleft leg, requiring opiate analgesia prior to packing. The size of thetumor lesion was 6.6 cm. After two cycles of treatment with monoclonalantibody 2C4 (10 mg/kg), the patient could be wound packed without theadministration of any additional analgesic agent. The tumor itself didnot respond to 2C4 antibody treatment, but 2C4 exhibited analgesicactivity.

Example 6 rhuMAb 2C4 for Treating Pain Associated withAndrogen-Independent Prostate Cancer

Patients diagnosed with hormone-resistant (androgen-independent)prostate cancer with bony metastasis, which had progressed aftertaxane-based chemotherapy, were treated with rhuMAb 2C4. All patientsrecorded a Present Pain Intensity Score of 1 or more on a 6 point scale(McGill Pain Index) prior to starting rhuMAb 2C4 administration, where

-   -   0=no pain    -   1=mild pain    -   2=discomforting pain    -   3=distressing pain    -   4=horrible pain    -   5=excruciating pain.

The analgesia intake of the patients was measured using a daily diary.One dose of a non-steroidal analgesic agent was assigned a score of 1,one 10-mg dose of morphine or an equivalent dose of another opiateanalgesic was assigned a score of 2.

rhuMAb 2C4 was administered starting with a 840 mg loading bolus dosefollowed by a 420 mg intravenous (i.v.) dose every three weeks.

One patient has a fall in pain score from 3 to 1, with modest reductionin analgesia requirement. This effect lasted for 24 weeks. The patientshowed a reduction in the rate of rise of PSA, but no reduction inabsolute value.

One patient had a stable pain score of 2, but stopped all analgesia. Theeffect is ongoing at 24 weeks, despite progression of PSA.

One patient showed an initial improvement in pain (score was reducedfrom 2 to 1) with more than 50% reduction in analgesia requirement. Thetreatment had no effect on the PSA of the patient. The effect on painlasted for 6 weeks, then the disease progressed and pain increased.

The data show that rhuMAb 2C4 was able to reduce and stabilize the painof patients even when prostate cancer was not in remission or continuedto progress.

1. A method of treating pain in a patient comprising administering anErbB antagonist to the patient in a dose confirmed to reduce oreliminate the pain or the analgesia requirement of the patient.
 2. Themethod of claim 1 wherein pain is measured by a pain score or quality oflife score reflective of pain.
 3. The method of claim 2 wherein pain ismeasured by the McGill Pain Index on a six point scale of 0 to
 5. 4. Themethod of claim 2 wherein pain is measured using a visual analog scaleof 0-100 reflective of the subjective feeling of pain of the patient. 5.The method of claim 1 wherein analgesia requirement is measured using ananalgesia score.
 6. The method of claim 5 wherein one dose of anon-steroidal analgesic agent corresponds to an analgesia score of 1,and one 10 mg dose of morphine, or an equivalent dose of another opiateanalgesic agent corresponds to an analgesia score of
 2. 7. The method ofclaim 1 wherein pain is monitored daily.
 8. The method of claim 1wherein analgesia requirement is monitored daily.
 9. The method of claim1 wherein the antagonist is an antibody that binds an ErbB.
 10. Themethod of claim 9 wherein the antibody blocks ligand activation of anErbB.
 11. The method of claim 9 wherein the antibody blocks formation ofan ErbB heterodimer.
 12. The method of claim 9 wherein the antibodyblocks binding of monoclonal antibody 2C4 to ErbB2.
 13. The method ofclaim 9 wherein the antibody has a biological characteristic ofmonoclonal antibody 2C4.
 14. The method of claim 9 wherein the antibodycomprises monoclonal antibody 2C4 or humanized 2C4.
 15. The method ofclaim 9 wherein the antibody is an antibody fragment.
 16. The method ofclaim 15 wherein the antibody fragment is a Fab fragment.
 17. The methodof claim 9 wherein the antibody is not conjugated with a cytotoxicagent.
 18. The method of claim 9 wherein the antibody is conjugated witha cytotoxic agent.
 19. The method of claim 15 wherein the antibodyfragment is not conjugated with a cytotoxic agent.
 20. The method ofclaim 15 wherein the antibody fragment is conjugated with a cytotoxicagent.
 21. The method of claim 1 wherein the pain is chronic pain. 22.The method of claim 21 wherein the chronic pain is selected from thegroup consisting of nociceptive pain, neuropathic pain and psychogenicpain.
 23. The method of claim 22 wherein the pain is nociceptive pain.24. The method of claim 1 wherein the pain is cancer related pain. 25.The method of claim 24 wherein the cancer expresses an ErbB receptor.26. The method of claim 25 wherein the ErbB receptor is ErbB2 or EGFR.27. The method of claim 24 wherein the cancer is metastatic cancer. 28.The method of claim 27 wherein the pain is associated with cancermetastasis.
 29. The method of claim 26 wherein the cancer is prostatecancer.
 30. The method of claim 29 wherein the metastasis is bonemetastasis.
 31. The method of claim 24 wherein the cancer is selectedfrom the group consisting of breast cancer, ovarian cancer, prostatecancer, pancreatic cancer, squamous cell cancer, lung cancer, cancer ofthe peritoneum, hepatocellular cancer, gastric cancer, glioblastoma,cervical cancer, liver cancer, bladder cancer, hepatoma, colon cancer,rectal cancer, colorectal cancer, endometrial or uterine carcinoma,salivary gland carcinoma, kidney cancer, vulval cancer, thyroid cancer,hepatic carcinoma, anal carcinoma, penile carcinoma, and head and neckcancer.
 32. The method of claim 31 wherein the cancer is prostatecancer.
 33. The method of claim 32 wherein the cancer is androgenindependent prostate cancer.
 34. The method of claim 24 wherein thecancer is not in remission or continues to grow during treatment. 35.The method of claim 1 wherein the pain is non-cancer related.
 36. Themethod of claim 1 wherein the patient is not suffering from malignancy.37. A method for treating cancer-related pain in a patient diagnosedwith cancer, comprising administering an effective amount of an ErbBantagonist to the patient, wherein the cancer is not in remission orcontinues to grow during said treatment.
 38. The method of claim 37wherein the cancer is not in remission during said treatment.
 39. Themethod of claim 37 wherein the cancer continues to grow during saidtreatment.
 40. The method of claim 37 wherein the cancer is selectedfrom the group consisting of breast cancer, ovarian cancer, prostatecancer, pancreatic cancer, squamous cell cancer, lung cancer, cancer ofthe peritoneum, hepatocellular cancer, gastric cancer, glioblastoma,cervical cancer, liver cancer, bladder cancer, hepatoma, colon cancer,rectal cancer, colorectal cancer, endometrial or uterine carcinoma,salivary gland carcinoma, kidney cancer, vulval cancer, thyroid cancer,hepatic carcinoma, anal carcinoma, penile carcinoma, and head and neckcancer.
 41. The method of claim 37 wherein the cancer is metastaticcancer.
 42. The method of claim 41 wherein the metastasis is soft tissuemetastasis.
 43. The method of claim 41 wherein the metastasis includesbone metastasis.
 44. The method of claim 40 wherein the cancer isprostate cancer.
 45. The method of claim 44 wherein the cancer isandrogen independent prostate cancer.
 46. The method of claim 44 whereinthe patient's PSA shows no reduction during treatment.
 47. The method ofclaim 44 wherein the patient's PSA becomes elevated during treatment.48. The method of claim 37 wherein the antagonist is an antibody thatbinds an ErbB.
 49. The method of claim 48 wherein the antibody blocksligand activation of an ErbB.
 50. The method of claim 48 wherein theantibody blocks formation of an ErbB heterodimer.
 51. The method ofclaim 48 wherein the antibody blocks binding of monoclonal antibody 2C4to ErbB2.
 52. The method of claim 48 wherein the antibody has abiological characteristic of monoclonal antibody 2C4.
 53. The method ofclaim 48 wherein the antibody comprises monoclonal antibody 2C4 orhumanized 2C4.
 54. The method of claim 48 wherein the antibody is anantibody fragment.
 55. The method of claim 54 wherein the antibodyfragment is a Fab fragment.
 56. The method of claim 48 wherein theantibody is not conjugated with a cytotoxic agent.
 57. The method ofclaim 48 wherein the antibody is conjugated with a cytotoxic agent. 58.The method of claim 54 wherein the antibody fragment is not conjugatedwith a cytotoxic agent.
 59. The method of claim 54 wherein the antibodyfragment is conjugated with a cytotoxic agent.
 60. A method for treatingnon-cancer related pain in a patient comprising administering aneffective amount of an ErbB antagonist to the patient.
 61. The method ofclaim 60 wherein the antagonist is an anti-ErbB antibody.
 62. The methodof claim 61 wherein the antibody blocks ligand activation of an ErbB.63. The method of claim 61 wherein the antibody blocks formation of anErbB heterodimer.
 64. The method of claim 61 wherein the antibody blocksbinding of monoclonal antibody 2C4 to ErbB2.
 65. The method of claim 61wherein the antibody has a biological characteristic of monoclonalantibody 2C4.
 66. The method of claim 61 wherein the antibody comprisesmonoclonal antibody 2C4 or humanized 2C4.
 67. The method of claim 61wherein the antibody is an antibody fragment.
 68. The method of claim 67wherein the antibody fragment is a Fab fragment.
 69. A kit comprising aneffective amount of an ErbB antagonist, and instructions to administersaid antagonist for the treatment of pain.
 70. The kit of claim 69wherein the antagonist is an antibody that binds an ErbB.
 71. The kit ofclaim 70 wherein the antibody blocks ligand activation of an ErbB. 72.The kit of claim 70 wherein the antibody blocks formation of an ErbBheterodimer.
 73. The kit of claim 70 wherein the antibody blocks bindingof monoclonal antibody 2C4 to ErbB2.
 74. The kit of claim 70 wherein theantibody has a biological characteristic of monoclonal antibody 2C4. 75.The kit of claim 70 wherein the antibody comprises monoclonal antibody2C4 or humanized 2C4.
 76. The kit of claim 70 wherein the antibody is anantibody fragment.
 77. The kit of claim 76 wherein the antibody fragmentis a Fab fragment.
 78. The kit of claim 69 wherein the pain iscancer-related.
 79. The kit of claim 69 wherein the pain is non-cancerrelated.
 80. The kit of claim 69 wherein the pain is chronic pain.